What is Ankyloglossia?

Ankyloglossia ("tongue tie") is the term used to describe a lingual frenum with a restricted range of motion falling outside the normal or acceptable limits. This limited range of motion may be the result of one of more of the following factors:

	the frenum is too short, tight, thick, or fibrosed
	its attachment is too close to the tip of the tongue
	it is fused to the floor of the mouth

Why be concerned about ankyloglossia?

Many health and dental specialists believe that a short lingual frenum (ankyloglossia) may contribute to and/or be a precursor to various other dental, speech, skeletal and abnormal oral myofunctional concerns.  If the tongue's elevation or flexibility are restricted, it will not be able to assume the preferred resting posture against the palate - which may result in malformation of the palate and dental arch; speech sounds  being incorrectly produced; and/or incorrect muscle function for swallowing and chewing.

How is ankyloglossia corrected?

A frenectomy or a frenotomy may be performed, followed by the patient's participation in post-operative oral myofunctional therapy.

For a frenectomy, the physician or dental specialist removes or excises a tight or short lingual frenum to free the tongue and allow for a greater range of motion.  The doctor makes incisions in the frenum both near the tongue and the mandible (lower jaw), which ultimately connects as they move posteriorly (towards the back).  The entire frenum is excised and the surgical wound is sutured.

For a frenotomy, the physician or dental specialist makes an incision or 'cut' in the lingual frenum, freeing the tongue and allowing for a greater range of motion.  sutures may be used.

Post-operative oral myofunctional therapy - It is highly recommended that patients undergoing surgery for either procedure (frenectomy or frenotomy) follow up post-operatively with oral myofunctional therapy, provided by a Board certified Orofacial Myologist. Therapy visits generally consist of weekly sessions which include therapeutic exercises, activities and neuromuscular re-education. The patient will need to strengthen and tone his/her tongue muscles in order to gain better control, learn new tongue placements and muscle function to improve mastication (chewing) and articulation, and relearn proper swallowing and mouth resting posture habits  Most often when no therapy is provided, the patient will continue his/her abnormal  rest posture of the tongue, lips, and mandible, as well as abnormal oral functions - which lead to continued medical, orthodontic/dental, and oral myofunctional concerns that do not always self-correct.

How does one assess if a lingual frenectomy or frenotomy is indicated?

Examine - Measure - Observe

Examine - Is lingual movement restricted to a degree that prevents a normal oral/lingual resting posture?

	Is the mandibular insertion contributing to and/or causing recession of the attached gingiva?
	Does the patient exhibit difficulties with their speech - especially r,s,l,t?
	Does the patient exhibit oral myofunctional concerns: abnormal mouth resting posture; abnormal or difficulty swallowing; mandible shifting; difficulty with chewing and/or gathering food?
	Can the patient protrude or elevate the tongue successfully?
	Are there temporomandibular concerns?
	Does the patient have symptoms of snoring; hoarseness; fatigue; sleep apnea; an obstructive feeling in the throat?
	Does the patient have difficulty wearing an orthodontic/dental appliance?
	Does the patient have dental/skeletal concerns?

Measure - measure the patient's maximum opening to the inter-incisal distance by either: placing a pedo-block in the bicuspid area and having the patient occlude on the block while reaching the tip of the tongue to the palate. Are they able to lift the tongue tip to this area and maintain contact?  or have the patient place their index and middle fingers into their mouth vertically - near the bicuspids or molars - and then lift their tongue to achieve a lingua-palatal seal. Are they able to do this?

Observe - the insertion of the lingual frenum - that is, where it attaches to the tongue - is it close to the tip of the tongue? Is it webbed? How close is it to the attached gingival?  Also observe for any anomalies or differences. Are there cones?  Is there thickness and/or scarring on the frenum?

Copyright 2001, R. Michael Nelson