- Ankyloglossia
Infobox_Disease
Name = PAGENAME
Caption = Child with ankyloglossia.
DiseasesDB = 33478
ICD10 = ICD10|Q|38|1|q|38
ICD9 = ICD9|750.0
ICDO =
OMIM =
MedlinePlus =
eMedicineSubj =
eMedicineTopic =
MeshID =Ankyloglossia, commonly known as tongue tie, is a
congenital oral anomaly which may decrease mobility of thetongue tip cite journal |author=Messner AH, Lalakea ML |title=The effect of ankyloglossia on speech in children |journal=Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery |volume=127 |issue=6 |pages=539–45 |year=2002 |pmid=12501105 |doi=10.1067/mhn.2002.1298231] and is caused by an unusually short, thicklingual frenulum , a membrane connecting the underside of the tongue to the floor of the mouth.cite journal |author=Horton CE, Crawford HH, Adamson JE, Ashbell TS |title=Tongue-tie |journal=The Cleft palate journal |volume=6 |issue= |pages=8–23 |year=1969 |pmid=5251442 |doi=] Ankyloglossia varies in degree of severity from mild cases characterized bymucous membrane bands to complete ankyloglossia whereby thetongue is tethered to the floor of themouth .Incidence
The incidence of ankyloglossia has been reported from .02 percent to 4.8 percent.cite journal |author=Lalakea ML, Messner AH |title=Ankyloglossia: does it matter? |journal=Pediatr. Clin. North Am. |volume=50 |issue=2 |pages=381–97 |year=2003 |pmid=12809329 |doi=] According to Lalakea and Messner, the different reports of incidence may be due to the lack of objective grading systems and uniform definitions of ankyloglossia. It has been found to occur more frequently in
males than infemales , with a 2.6:1ratio .Messner, Anna H., Lalakea, M. Lauren, Aby, Janelle, Macmahon, James, Bair, Ellen (2000). Ankyloglossia: Incidence and associated feeding difficulties. Otolaryngology – Head and Neck Surgery. 126, 36-39.] Theprevalence of ankyloglossia has been shown to increase with maternal use ofcocaine .cite journal |author=Harris EF, Friend GW, Tolley EA |title=Enhanced prevalence of ankyloglossia with maternal cocaine use |journal=Cleft Palate Craniofac. J. |volume=29 |issue=1 |pages=72–6 |year=1992 |pmid=1547252 |doi=] Harris "et al." examined 500infants at a well-baby nursery and found that ankyloglossia occurred in 3.5 percent of non-drug users’offspring and 10.4 percent of cocaine-users’ offspring. The study also found that ankyloglossia was not dependent on race. Limitations of this study include that examiners were not blinded to the purpose of the study and the effects of ankyloglossia in the infants were not assessed.Diagnosis
Effects
Ankyloglossia can affect
feeding , speech andoral hygiene Travis, Lee Edward (1971). Handbook of speech language pathology and audiology. New York, New York: Appleton-Century-Crofts Education Division Meredith Corporation.] as well as havemechanical/social effects .Lalakea, M. Lauren, Messner, Anna H. (2003a). Ankyloglossia: The adolescent and adult perspective. Otolaryngology – Head and Neck Surgery. 128 (5), 746-752.] Ankyloglossia can also prevent the tongue from contacting theanterior palate . This can then promote an infantile swallow and hamper the progression to an adult-like swallow which can result in anopen bite deformity. It can also result inmandibular prognathism ; this happens when the tongue contacts the anterior portion of themandible with exaggerated anterior thrusts.Professional opinion
Opinion varies, however, regarding how frequently ankyloglossia truly causes problems. Some professionals believe it is rarely symptomatic, whereas others believe it is associated with a variety of problems. The disagreement among professionals was documented in a study by Messner and Lalakea (2000).cite journal |author=Messner AH, Lalakea ML |title=Ankyloglossia: controversies in management |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=54 |issue=2-3 |pages=123–31 |year=2000 |pmid=10967382 |doi=] The authors sent a survey to a total of 1598
otolaryngologists ,pediatricians ,speech-language pathologists andlactation consultants with questions to ascertain their beliefs on ankyloglossia; 797 of the surveys were fully completed and used in the study. It was found that 69 percent of lactation consultants but only a minority of pediatricians answered that ankyloglossia is frequently associated with feeding difficulties; 60 percent of otolaryngologists and 50 percent of speech pathologists answered that ankyloglossia is sometimes associated with speech difficulties compared to only 23 percent of pediatricians; 67 percent of otolaryngologists compared to 21 percent of pediatricians answered that ankyloglossia is sometimes associated with social and mechanical difficulties. Limitations of this study include a reducedsample size due to unreturned or incomplete surveys.Feeding
Messner "et al." studied ankyloglossia and infant feeding. Thirty-six infants with ankyloglossia were compared to a
control group without ankyloglossia. The two groups were followed for six months to assess possiblebreastfeeding difficulties, defined asnipple pain lasting more than six weeks, or infant difficulty latching onto or staying onto the mother’s breast. Twenty-five percent of mothers of infants with ankyloglossia reported breast feeding difficulty compared with only 3 percent of the mothers in the control group. The study concluded that ankyloglossia can adversely affect breastfeeding in certain infants. Infants with ankyologlossia do not, however, have such big difficulties when feeding from abottle .Lalakea, M. Lauren, Messner, Anna H. (2002). Frenotomy and frenuloplasty: If, when and how. Operative Techniques in Otolaryngology – Head and Neck Surgery. 13 (1), 93-97.] Limitations of this study include the small sample size and the fact that the quality of the mother’s breast feeding was not assessed. By immediately cutting the frenulum upon discovery of ankyloglossia most of the breast feeding issues will disappear instantly.Wallace and Clark also studied breastfeeding difficulties in infants with ankyloglossia.Wallace, Helen, Clarke, Susan (2006). Tongue tie division in infants with breast feeding difficulties. International Journal of Pediatric Otorhinolaryngology. 70, 1257-1261.] They followed 10 infants with ankyloglossia who underwent surgical tongue tie division. Eight of the ten mothers experienced poor infant latching onto the breast, 6/10 experienced sore nipples and 5/10 experienced continual feeding cycles; 3/10 mothers were exclusively breastfeeding. Following a tongue tie division, 4/10 mothers noted immediate improvements in breastfeedings, 3/10 mothers did not notice any improvements and 6/10 mothers continued breastfeeding for at least four months after the
surgery . The study concluded that tongue tie division may be a possible benefit for infants experiencing breastfeeding difficulties due to ankyloglossia and further investigation is warranted. The limitations of this study include that the sample size was small and that there was not a control group. In addition, the conclusions were based on subjective parent report as opposed to objective measures.Speech
Messner and Lalakea studied speech in children with ankyloglossia. They noted that the phones likely to be affected due to ankyloglossia include
sibilants andlingual sounds such as [t d z s θ ð n l] . In addition, the authors also state that it is uncertain as to which patients will have aspeech disorder that can be linked to ankyloglossia and that there is no way to predict at a young age which patients will need treatment. The authors studied 30 children from one to 12 years of age with ankyloglossia, all of whom underwentfrenuloplasty . Fifteen children underwent speech evaluation before and after surgery. Eleven patients were found to have abnormal articulation before surgery and nine of these patients were found to have improved articulation after surgery. Based on the findings, the authors concluded that it is possible for children with ankyloglossia to have normal speech in spite of decreased tongue mobility. However, according to their study, a large percent of children with ankyloglossia will have articulation deficits that can be linked to tongue tie and these deficits may be improved with surgery. The authors also note that ankyloglossia does not cause a delay in speech or language but, at the most, problems with articulation. Limitations of the study include a small sample size as well as a lack of blinding of the speech-language pathologists who evaluated the subjects’ speech.While the tongue tie exists, and even years after removal, common speech abnormalities include mispronounication of words. The most common is Ws as Ls; for example the word "lemonade" would come out as "wemonade."
Mechanical/Social
Ankyloglossia can result in mechanical and social effects. Lalakea and Messner studied 15 people, aged 14 to 68 years. The subjects were given
questionnaires in order to assess functional complaints associated with ankyloglossia. Eight subjects noted one or more mechanical limitations which included cuts or discomfort underneath the tongue and difficulties withkissing , licking one’s lips, eating anice cream cone , keeping one’s tongue clean and performing tongue tricks. In addition, seven subjects noted social effects such as embarrassment andteasing . The authors concluded that this study confirmed anecdotal evidence of mechanical problems associated with ankyloglossia and that it suggests that the kinds of mechanical and social problems noted may be more prevalent than previously thought. Furthermore, the authors note that some patients may be unaware of the extent of the limitations they have due to ankyloglossia since they have never experienced normal tongue range. A limitation of this study is the small sample size that also represented a large age range.Intervention
There are varying types of intervention for ankyloglossia. Horton "et al." have a classical belief that people with ankyloglossia can compensate in their speech for limited tongue range of motion. For example, if the tip of the tongue is restricted for making sounds such as /n, t, d, l/, the tongue can compensate through
dentalization ; this is when the tongue tip moves forward and up. When producing /r/, elevation of the mandible can compensate for restriction of tongue movement. Also, compensations can be made for /s/ and /z/ by using thedorsum of the tongue for contact against thepalatal rugae . Thus, Horton "et al." proposedcompensatory strategies as a way to counteract the adverse effects of ankyloglossia and did not promote surgery.However, intervention for ankyloglossia sometimes includes surgery in the form of
frenotomy (also called a frenectomy or frenulectomy) or frenuloplasty. This may be done by laser. However, authors such as Horton "et al." ) are currently in opposition to it. According to Lalakea and Messner, surgery can be considered for patients of any age with a tight frenulum as well as a history of speech, feeding or mechanical/social difficulties. Adults with ankyloglossia may elect the procedure. Some of those who have done so report post-operative pain.A viable alternative to surgery is to take a wait-and-see approach. Ruffoli "et al." report that the frenulum naturally recedes during the process of a child’s growth between six months and six years of age;cite journal |author=Ruffoli R, Giambelluca MA, Scavuzzo MC, "et al" |title=Ankyloglossia: a morphofunctional investigation in children |journal=Oral diseases |volume=11 |issue=3 |pages=170–4 |year=2005 |pmid=15888108 |doi=10.1111/j.1601-0825.2005.01108.x |doi_brokendate=2008-06-23]
Conclusion
In conclusion, ankyloglossia can have feeding, speech and mechanical/social effects as well as result in other problems such as an open bite and mandibular prognathism. There is professional disagreement regarding how often ankyloglossia is symptomatic. In addition, intervention is also controversial as researchers such as Horton "et al." believe that people with ankyloglossia can compensate in their speech for limited tongue range of motion and do not require surgery.
References
Wikimedia Foundation. 2010.