Ankyloglossia, or tongue-tie as it is more commonly known, is said to exist when the inferior frenulum attaches to the bottom of the tongue and subsequently restricts free movement of the tongue. At one time such restriction was believed to cause speech problems and it was routine to clip the membranous frenulum (frenulectomy) in the nursery or physician's office to free the tongue tip (Godley, 1994; Schuller and Schleuning, 1994). Ankyloglossia occurs in approximately 1.7% of all neonates without preference for either sex and is reported to be transitory (Jorgenson et al, 1982). With growth, the frenulum lengthens so normal tongue function is established (Dilley, Siegel, and Budnick, 1991). The criteria for diagnosis is based upon observation of lingual mobility; no current specific indications for surgery are emphasized in either the dental or medical literature reviewed (Godley, 1994). Most of the current literature recommends that the frenulum not be clipped with sterile scissors or scalpel, as was the tradition at one time, but rather that either a laser frenulectomy or a Z-plasty under general anesthesia be performed (Godley, 1994; Pediatric Surgery Update, 1996). Simple incision of the frenulum may result in the development of scar tissue and further restriction of tongue movement (Schuller and Scleuning, 1994). Some authors indicate that if the tongue is able to touch the lower incisor teeth or just beyond the lower teeth, articulation will not be adversely affected (Schuller and Schleuning, 1994). In some cases the frenulum is reported to tear spontaneously during infancy.
There are reports in the nursing literature that link a tight lingual frenulum with ineffective latch-on and successful breast feeding. These accounts related that a tight lingual frenulum caused the tongue to appear heart-shaped at its tip and the net result was the tongue's inability to touch the roof of the mouth and successfully breast feed (Wiessinger and Miller, 1995; Notestine, 1990). Other associated problems with tight lingual frenulum include speech problems and nipple soreness in breast feeding mothers.
The medical electronic literature surveyed does not specifically address ankyloglossia in the neonatal period as being problematic in healthy infants. If the condition persists beyond 2 and one half to 3 years it is recommended that an evaluation be made to decide if a frenulectomy is indeed required for either feeding or speech problems (Dilley et al, 1991). There are case reports of physicians and dentists performing frenulectomy in the office for infants with persistent ankyloglossia and, in some cases, delayed physical growth, to assist with breast feeding, following the procedure the infants had successfully latch on, effective breast feeding and age-appropriate growth (Wiessinger and Miller, 1995).
During the routine newborn examination the nurse should evaluate the infant's tongue in relation to mobility and ability to suck. An excessively tight lingual frenulum which indeed restricts any tongue movement and ability to latch on effectively to the breast, take milk from a bottle appropriately or swallow should be further evaluated. An infant with growth failure or failure to thrive should undergo a complete physical examination with particular emphasis on observation of feeding method by the primary caretaker and an evaluation of the ability to effectively suck and swallow. Toddlers and preschoolers with expressive language difficulties should be closely evaluated for tongue mobility and hearing (audiology).
See Chapter 8 in
Nursing Care of Infants and
Children, 5th and 6th editions.
See Chapter 8 in Essentials of Pediatric Nursing, 5th edition.
March 15, 2002