Ankylogossia
Ankyloglossia
Ankyloglossia, often referred to as “tongue tie,” is a common congenital anomaly that is usually detected soon after birth. It is characterized by partial fusion-or in rare cases, total fusion-of the tongue to floor of the mouth due to an abnormality of the lingual frenulum.
By definition, a frenulum, which is a small frenum, is a narrow fold of mucous membrane connecting a moveable part to a fixed part. Its purpose is to stabilize and check undue movement of that part. The lingual frenulum is generally under the mid-portion of the tongue. As such, it can help to stabilize the base of the tongue but does not interfere with tongue tip movement. With ankyloglossia, however, the lingual frenulum has an anterior attachment near the tip of the tongue and may also be unusually short. This causes virtual adhesion of the tongue tip to the floor of the mouth and can result in restricted tongue tip movement to some extent.
The diagnostic characteristics of ankyloglossia are easy to detect. Usually, the patient is unable to protrude the tongue past the edge of the lower gingiva or mandibular incisors. With protrusion attempts, the tongue tip becomes notched in midline, resulting in a heart-shaped edge. In addition, the patient is unable to touch the roof of the mouth with the tongue tip when the mouth is open. A diagnostic classification system of severity has been proposed by Kotlow (1999).
The prevalence of ankyloglossia is unclear, since the reported figures vary significantly from less than 1% to as frequent as 97% in newborns (Lewis & Counihan, 1965). More recent reports place the prevalence at about 4%-5% in newborns (Messner et al., 2000; Ricke et al., 2005).
Although ankyloglossia can be significant at birth, the severity and functional effects tend to decrease with time and oral growth. During the first 4 to 5 years of life, the oral cavity changes significantly in shape and size. The alveolar ridge grows in height, the teeth begin to erupt, and the tongue grows and narrows at the tip. At the same time, the lingual frenulum recedes, stretches, and may even rupture. Therefore, as the child grows, the severity of the tongue-tie lessens and the initial restrictions of lingual movement are diminished.