Ankyloglossia, commonly known as tongue-tie, is a condition present at birth that can restrict the tongue’s range of motion. It occurs when a band of tissue underneath the tongue, called the lingual frenulum, is unusually short, thick, or tight, tethering the tongue to the floor of the mouth.
Understanding Tongue-Tie
Tongue-tie is characterized by a lingual frenulum that prevents the tongue from moving freely, potentially limiting its ability to protrude, elevate, or move from side to side. This band of tissue is present in all individuals, but in those with ankyloglossia, it remains too short or tight. The appearance of the tongue can sometimes be indicative, with a heart-shaped or notched tip observed when the tongue is extended due to the restricted movement.
Its prevalence varies, affecting approximately 1% to 11% of newborns. It appears to be more common in boys than in girls. While some cases are barely noticeable, a restrictive frenulum can impact tongue function.
The Hereditary Aspect
Research suggests a strong genetic component to tongue-tie, as it often runs in families with multiple members across generations exhibiting the condition. Although the exact genetic causes are still being investigated, certain genes have been implicated in its development. For instance, variations in the TBX22 gene, located on the X chromosome, have been associated with tongue-tie, particularly in cases linked with cleft palate. Additionally, mutations in the MTHFR gene, which influences amino acid processing and tissue development, have been linked to an elevated risk of tongue-tie and other oral anomalies.
How Tongue-Tie is Passed Down
Tongue-tie is frequently observed to follow an autosomal dominant inheritance pattern. In this mode of inheritance, only one copy of an altered gene from either parent is needed for the condition to manifest in the offspring. This means that each child of an affected parent has a 50% chance of inheriting the genetic predisposition for tongue-tie. It is also important to consider variable expressivity, where individuals with the same genetic alteration can experience different levels of severity in their symptoms. This means that even within the same family, some individuals might have a pronounced tongue-tie, while others exhibit a milder form or are asymptomatic carriers.
Recognizing and Addressing Tongue-Tie
Identifying tongue-tie often involves observing specific signs and symptoms, which can vary depending on age. In infants, common indicators include difficulties with breastfeeding, such as a poor latch, frequent detachment from the breast, or clicking sounds during feeding. Mothers may experience nipple pain, soreness, or even a reduced milk supply. Poor weight gain in the infant can also be a sign of feeding challenges related to tongue-tie.
As children grow, tongue-tie can lead to speech articulation issues, particularly with sounds requiring the tongue to reach the roof of the mouth or upper teeth, such as ‘t’, ‘d’, ‘s’, ‘z’, ‘l’, and ‘r’. They might struggle to lick an ice cream cone, clear food debris from their teeth, or even play wind instruments. Oral hygiene challenges, including increased risk of tooth decay, can also arise if the tongue’s movement is restricted.
Diagnosis typically involves a physical examination by a healthcare professional, who assesses the tongue’s appearance and range of motion. In some cases, a lactation consultant may observe breastfeeding to determine if the tongue-tie is impacting feeding. If the condition causes problems, interventions may be recommended.
A frenotomy, a simple procedure involving a quick snip of the frenulum, is often performed, especially for infants. For thicker frenulums or older individuals, a frenuloplasty, a more extensive surgical procedure, might be considered. After treatment, tongue exercises may be recommended to improve movement and reduce scarring.