Ankyloglossia (tongue-tie)

Paul Hong

doi:10.1503/cmaj.120785

Ankyloglossia (tongue-tie) is a congenital condition with a prevalence of about 5%

In large cross-sectional studies of the condition in newborns, the prevalence has ranged from 4% to 10%.1 Boys are affected more than girls, with the sex ratio being about 2:1. There is no clear ethnic predilection.2

There are no known causes of ankyloglossia

Ankyloglossia usually occurs without other congenital anomalies (Figure 1). Familial patterns have been reported, but the inheritance pattern is unclear.2 Rarely, orofacial clefts (i.e., cleft lip, cleft palate) and other craniofacial syndromes have been reported with ankyloglossia.3

Figure 1:

An infant with ankyloglossia.

Most children with ankyloglossia are asymptomatic

Severe ankyloglossia may result in inadequate milk intake, prolonged feeding times, maternal nipple pain or bleeding, and rarely, failure to thrive.4^,5 Poor latching because of restricted tongue movements seems to be the underlying cause. Some newborns with symptoms may show spontaneous improvements in breastfeeding by learning to compensate.1

There is no evidence that ankyloglossia causes problems with articulation

There are reports of older children and adults undergoing tongue-tie release (frenotomy) to improve articulation and to relieve mechanical problems related to limited tongue movement (e.g., kissing and licking lips).2 However, definitive studies addressing the association between ankyloglossia and speech are lacking. A formal assessment by a speech pathologist may provide diagnostic information, and noninvasive therapeutic strategies may be instituted.

Tongue-tie release (frenotomy) is effective in relieving difficulties with breastfeeding due to severe ankyloglossia

Several observational studies and a few small randomized trials have shown the effectiveness of frenotomy. The procedure should be reserved for newborns who are having difficulties with breastfeeding due to severe ankyloglossia.1^,2^,4 Consultation with a health care professional who has expertise in breastfeeding, such as lactation consultants, neonatal nurses and occupational therapists, is recommended before referring a child for frenotomy.

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Footnotes

Competing interests: None declared.
This article has been peer reviewed.

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