Ankyloglossia is a term that originates from a Greek word "agkilos", meaning curved and glossa referring to the tongue, hence the term tongue-tie.
BEING a mother is the best feeling in the world, it comes with the joy of being able to carry a baby in the womb, waiting for nine months to deliver and holding it in your arms for the first time, it is such a beautiful moment.
The problem comes when breastfeeding becomes a challenge, you have probably tried all you can, but there is no improvement.
Hence you are obliged to go and find the cause of this problem and lo and behold, the doctor informs you that your baby has a condition called ankyloglossia or tongue-tie.
On the African continent, this condition is often believed to be a solvable problem, especially by our grandmothers, but the question is: Does this really help?
If not, what can you do as a parent if your child is diagnosed with this condition?
Ankyloglossia is a term that originates from a Greek word "agkilos", meaning curved and glossa referring to the tongue, hence the term tongue-tie.
Clinically, the tongue is observed to be fused to the floor of the mouth, but shows signs of a thick and short frenulum.
A frenulum of the tongue is defined as a thick tissue that connects the tongue to the floor of the mouth to restrict tongue movement and provide stability during function.
For example, when speaking, you would not want the tongue going all the way out.
During sleep, the frenulum helps to keep the tongue in place to avoid asphyxia because without proper fixation, the tongue can block the throat and prevent you from breathing.
The frenulum is also located on the gums to attach them to your lips, hence it is important to understand how this anatomical structure is vital to us.
Ankyloglossia restricts tongue movement.
The tongue's movement should be restricted, but also able to perform daily functions.
However, in tongue-tie patients, it is different.
Babies struggle even during breastfeeding, speech and articulation of words and experience other problems, which makes it an issue of great concern.
What causes ankyloglossia?
The exact cause of tongue-tie is idiopathic (unknown), but is often attributed to genetics and associated with X-linked cleft palate syndrome.
The transmission between generations, though X linked, it can vary according the severity of expression.
Probably this explains why more males are affected by the condition.
Problems associated with ankyloglossia
Limitation of the movement of the tongue could result in:
Ankyloglossia in infants is associated with a 25% to 60% incidence of difficulties in breastfeeding due to nipple damage, maternal breast pain, poor milk supply, breast engorgement and the refusal of the baby to breastfeed.
The main reason why breastfeeding is such an issue is because infants cannot extend their tongues over the lower gum line to form a proper seal with the mothers' breast and, therefore, must use their jaws to keep the breast inside the mouth which becomes difficult for both the mother and the baby.
The prevalence of nipple pain ranges from 60% to 80% in nursing mothers during the early postpartum (after birth) period.
Normally, pain is transient and often peaks on the third day resolving within two weeks, but with ankyloglossia, pain lasts for months and even years.
Limited mobility can pose difficulty in speech in the articulation of consonant sounds like "s, z, t, d, l, j, zh, ch, th, dg," and it is even more challenging to pronounce an "r".
However, it should be recognised that a slight difference in pronounciation can not always be diagnosed as a speech problem.
A tongue-tie condition can lead to malocclusion (misalignment of teeth or improper bite) due to the low position of the tongue causing forward and downward pressure on the lower jaw which leads to its protrusion.
This means that the mandible will assume a more forward position in relation to the maxilla or the upper jaw.
How can this issue be solved or what are the treatment options?
Ankyloglossia cannot be treated at home.
It needs the involvement of a healthcare professional usually a maxillofascial surgeon.
If the treatment is performed by a less qualified individual, it could lead to improper scarring that could lead to more problems aesthetically and functionally or lack of infection control due to the use of unsterile instruments.
There are three categories of surgical methods used to treat a tongue-tie.
The first method is called frenulotomy, which is a straightforward frenulum incision (cutting), which usually takes seconds and is performed without local anaesthestics.
The second method is called a frenulectomy, which is defined as the removal of the whole frenulum or total excision.
To relieve the tongue-tie and address the anatomic situation, the third method is called frenuloplasty, which uses a variety of techniques and it is up to the healthcare provider to choose the best procedure.
Treatment timing is very crucial, and it can differ based on clinical findings:
Surgery can be considered during the newborn period or the proactive window (first 4-8 weeks) if the child is experiencing breastfeeding difficulties, in this case early correction prevents the baby and the mother from developing inefficient or painful feeding habits that can be difficult to unlearn.
During the infancy period (2-12 months), surgery is considered if, for example, breastfeeding was not attempted or attempted, but was unsuccessful or if any problems arose after the newborn period.
This period is important because restrictive tongue movement can lead to difficulty in food manipulation and swallowing safely.
Sometimes during this period, issues like a heart-shaped tongue, inability to protrude the tongue or any significant gagging can be of prompt evaluation.
The toddler period or preschool years (1-5 years) is essential for speech articulation.
Ideally, it is important to visit the dental clinic or hospital earlier so that the maxillofacial surgeon can advise accordingly.