Tongue-tie

To review the presenting features of tongue-tie in childhood and indications for frenulotomy, drawing conclusions from a retrospective study of patients encountered in paediatric surgical practice and from the literature.

A disease index was kept enabling histories to be selected for analysis. All patients were seen by the author and all operations performed by the author or a registrar under supervision in a standard manner. Patients were reviewed 2 weeks after operation.

During 18 years of practice, 287 patients with simple tongue-tie were encountered (two others with true ankyloglossia were not included in this study) and 158 frenulotomies were performed. The presenting symptoms were related to sucking or swallowing (13%), speech (32%), mechanical problems related to restricted tongue movements (14%) and to other problems (3%). In 38% the asymptomatic tongue-tie was noted incidentally.

It is concluded that there is no place for division of tongue-tie without anaesthesia in the newborn. Speech difficulties related to tongue-tie are over-rated and mechanical problems are underestimated. The indications for frenulotomy include articulation difficulties confirmed by a speech pathologist, mechanical limitations such as inability to lick the lips, to perform internal oral toilet or play a wind instrument. There may be rare instances in infancy where problems with feeding and suction can be helped by frenulotomy but evidence for this is anecdotal. Operation requires general anaesthesia except in older, co-operative teenagers in whom local anaesthetic is appropriate.