What Is Ankyloglossia?

There are two main causes of ankyloglossia: a tongue-tie that is too short and problems in sliding the tongue-tie downward during the development stage.
What Is Ankyloglossia?

Last update: 19 December, 2022

Ankyloglossia, also known as tongue-tie, is the thickening or shortening of the lingual frenulum that causes the tongue to adhere to the floor of the mouth. This causes limitations in the movement of the tongue, which can hinder basic tasks. All babies are born with a shortened frenulum, although some cases are more serious than others.

This condition is very common. According to some estimates, between 4.2 to 10.7% of people suffer from it. Not all patients have symptoms or problems, and most of the time ankyloglossia resolves on its own during childhood. Others require surgical intervention, such as frenectomy. We’ll take a look at its symptoms, causes and treatment.

Symptoms of ankyloglossia

Ankyloglossia and problems opening the mouth.
The different types of tongue-tie can present problems in any aspect of daily life.

The way in which the tongue is attached to the lingual frenum and the frenum to the floor of the mouth are very varied. Not all of them cause complications, and they can’t always be classified as ankyloglossia. Etymologically it derives from the Greek etymon agkilos (‘curve’) and glossa (‘tongue’). The first use of the term dates back to the 1960s when AF Wallace defined it as:

“A condition in which the tip of the tongue is unable to protrude beyond the lower incisor teeth due to a short frenulum, often containing scar tissue.”

The term is used to describe very different clinical manifestations. Indeed, it can be used both to refer to a short frenulum, a very thick frenulum, or when the tongue is fused to the floor of the mouth. All this is useful to illustrate that the symptoms of ankyloglossia are very varied. Here are the main signs according to Johns Hopkins Medicine:

  • Difficulty raising the tongue towards the upper teeth
  • Problems sticking out the tongue beyond the lower incisors
  • Heart-shaped tongue when pushed forward
  • Inability to moisten the lips with the tongue
  • Inability to sweep food debris from the teeth with the tongue

The condition may or may not cause complications in daily activities. Some experts have suggested that it’s associated with inadequate milk intake during suckling, prolonged feeding times, pain or bleeding from the maternal nipple and, as a consequence, a failure to thrive. It has also been associated with problems articulating certain sounds.

Indeed, the limitations in moving the tongue prevent children and young people from pronouncing letters such as t, d, r, z, and l. This is because they require a range of motion that isn’t possible in moderate or severe cases of ankyloglossia. There may also be problems kissing, eating ice cream, playing wind instruments, and maintaining good oral hygiene.

Causes of ankyloglossia

There are two main causes of ankyloglossia: a tongue-tie that is too short, and problems in sliding the tongue-tie downward during the development stage. Indeed, and as we have already explained, all children are born with a shortened frenulum. This moves down as the months go by, and it corrects itself. It isn’t yet clear if there’s a genetic predisposition to develop it.

Diagnosis of ankyloglossia

Ankyloglossia and its treatment.
A clinical evaluation is necessary to diagnose ankyloglossia. Based on its severity, it’s possible to propose different types of treatment.

There are several classification criteria for ankyloglossia. The most popular of all is the Coryllo Ankyloglossia Grading Scale. This divides the clinical symptoms into four types. Let’s see what they are and their characteristics:

  • Type I: The presence of a thin and elastic frenulum that anchors the tip of the tongue to the part behind the lower incisors.
  • Type II: The presence of a thin and elastic frenulum that anchors the tongue 2 to 4 millimeters from the tip to the floor of the mouth, very close to the posterior edge of the lower incisors.
  • Type III: The presence of a thick, rigid frenulum that anchors the tongue from the bottom half to the floor of the mouth.
  • Type IV: The frenulum is posterior, so it can’t be seen. However, by touching the area with the fingertips, the specialist can feel fibers that anchor the tongue.

During the diagnosis, the degree of mobility of the tongue can also be evaluated. It’s often done using the Hazelbaker Assessment Tool for Tongue Tie Function (HATLFF). A speech therapist together with an otolaryngologist can make the diagnosis.

Treatment options

Most episodes resolve on their own during a person’s natural development. If this hasn’t occurred, or if its manifestation interferes with the lactation process, then several treatment options can be considered. Experts recommend two surgical techniques for this: frenotomy and frenectomy (or frenuloplasty). Let’s see what they consist of:

  • Frenotomy: A procedure that releases the frenulum from its union with the tongue to facilitate its mobility. It’s the gold standard procedure in most cases. In general, it’s a safe procedure that offers relief both for the patient and for their mother (when carried out on lactating children).
  • Frenectomy: Basically this is plastic surgery of the frenulum, and is used in the most serious cases. The procedure is minimally invasive and is usually accompanied by speech therapy and exercises to strengthen the tongue.

Surgery can be performed at any age, so it’s not just for babies or children. During adolescence, it can generate self-esteem problems, and also during adulthood.

Whenever the specialist recommends it, surgical interventions are a viable option. The recovery process varies according to the severity, and certain habits can speed it up and promote healing.

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