Lingual frenulum in children, also known as ankyloglossia or tongue tie, is a congenital condition that often affects various areas of child development, such as feeding, especially during infancy, or speech. Although it does not always cause significant problems, in many cases it usually requires medical intervention. Understanding the causes, symptoms, and treatment options is essential for any parent or caregiver to make the best decision for their child.

What is lingual frenulum in children?

The lingual frenulum is a thin band of tissue that connects the underside of the tongue to the floor of the mouth. In most children, this tissue is flexible and does not interfere with normal tongue movement. However, some children are born with an abnormally short and tight lingual frenulum that restricts tongue mobility. This condition is known as ankyloglossia or tongue-tie.

Types of lingual frenulum

Although the basis of the condition is the same, there are different types of tongue-tie, or different degrees, depending on the tongue's ability to move and the severity of the symptoms. These are the main types:

• Class 1 or mild: tongue movement is not significantly affected, the child can speak normally and has few to no symptoms.
• Class 2 or moderate: at this level, the frenulum is tighter and somewhat limits tongue movement, such as moving it sideways, although these limitations are usually not severe.
• Class 3 or serious: there are problems performing basic activities such as breastfeeding or making certain sounds when speaking.
• Class 4 or very serious: in this case, the tongue is practically immobilized. The frenulum is so restrictive that the tongue can barely move, which causes serious difficulties both in breastfeeding and in the development of speech.

Why does it happen?

Short lingual frenulum, or ankyloglossia, is a congenital condition, meaning it is present from birth. It is thought to occur due to incomplete development of the lingual frenulum during gestation, when this tissue does not separate properly from the tongue before birth.

Although the specific causes of why it occurs are not known with certainty, there is evidence to suggest a genetic component, as the condition often runs in families.

What are the symptoms?

As explained above, the symptoms of ankyloglossia vary depending on the severity of the lingual frenulum and the age of the child. Some children do not have significant symptoms, while others experience the following difficulties:

• Difficulties in breastfeeding: in babies, a short frenulum makes it difficult for them to latch on to the nipple properly, causing insufficient weight gain and pain in the mother's nipples.

• Speech problems: as children grow older, they begin to have difficulty producing certain sounds, especially those that require the tongue to touch or come close to the roof of the mouth or teeth. These include the sounds of the letters "T," "D," "S," "L," and "R."

• Difficulty moving the tongue: problems sticking the tongue out beyond the lips or moving it from side to side, affecting activities such as licking or playing wind instruments.
• Unusual shape of the tongue: in some cases, the tongue takes on a heart shape or appears split at the tip when trying to remove it from the mouth.

What happens if a child has a tongue tie?

In some cases, children with ankyloglossia do not experience significant problems and the condition resolves on its own as they grow, as the frenulum may stretch or become less restrictive over time.

However, when the condition is severe enough, it will cause feeding problems in childhood, which in turn will affect both growth and development. In the long term, ankyloglossia could interfere with speech development and make it impossible to perform certain activities that require tongue mobility.

How is frenulum cured in children?

Again, treatment will depend on the severity of the tongue-tie. In many cases, especially when the tongue-tie is mild, no medical intervention is required as the tongue-tie may naturally stretch over time. However, if tongue-tie is causing feeding or speech problems

Frenotomy

It is a simple surgical procedure that involves cutting the lingual frenulum to free the tongue. It can almost always be performed quickly in the doctor's office without the need for general anesthesia.

Frenectomy

In more severe cases, a frenectomy is necessary, which involves the complete removal of the lingual frenulum. This is a procedure that requires local or general anesthesia, especially in older children, and is usually performed if the frenulum is thick or if the frenotomy has not been sufficient.

Frenuloplasty

This is a more advanced option in which different surgical techniques are used to correct the tongue tie. It is performed in complex cases or when the tongue tie is extremely restrictive. After the intervention, the child will need speech therapy to learn to use the muscles of the tongue more effectively.

When should tongue-tie surgery be performed?

Opting for any of the surgical procedures mentioned in the previous section is recommended when:

• Problems with breastfeeding: if the baby has difficulty latching on to the nipple or is not gaining weight properly.
• Speech difficulties: when the frenulum prevents the correct pronunciation of sounds such as "T", "D", "S", "L", and "R".
• Swallowing problems: if the tongue cannot move normally to swallow food.
• Dental problems: in some cases, a short frenulum can influence the development of teeth and bite.

At what age can a child undergo tongue-tie surgery?

Surgery to correct the lingual frenulum, such as a frenotomy or frenectomy, can be performed at any age, but the recommendation to intervene varies depending on the severity of the symptoms and the impact it has on the child's life.

However, if the problem is not detected or treated in childhood, lingual frenulum can be corrected later, even in adolescence or adulthood. In older children or adults, surgery often requires general anesthesia and a more complex approach, such as frenuloplasty, which may even involve the need for stitches. At this age, the patient is also more likely to need speech therapy after the procedure.

Care after lingual frenulum surgery in children

Once lingual frenulum surgery, whether a frenotomy or frenectomy, is performed, it doesn't mean that the process is over. Postoperative care is essential to ensure a quick and uncomplicated recovery. While the exact care guidelines should be explained by your doctor, we'll explain them to you in general terms so that you know what to expect:

Immediate care

In the first few hours after surgery, it is normal for the child to experience mild discomfort, which can be managed with common painkillers, such as paracetamol, prescribed by the doctor. If local anesthesia has been used, the area will remain numb for a short period of time. Similar to when you go to the dentist.

Feeding

If the baby is breastfed, it is recommended to try breastfeeding as soon as possible after surgery. In many cases, the baby will experience an immediate improvement in sucking. If the child is older, it is advisable to offer soft foods or liquids during the first few days to avoid discomfort.

Healing and tongue exercises

In the days following surgery, your doctor or speech therapist may recommend tongue-stretching exercises to prevent the frenulum from reattaching and limiting your range of motion. These exercises are usually simple, such as lifting your tongue toward the roof of your mouth or moving it from side to side, and they help promote proper healing.

Oral hygiene

It is essential to maintain good oral hygiene to avoid infections in the surgical area. It is recommended to rinse your mouth gently with water or a saline rinse, and avoid using brushes or hard objects near the surgical area during the first few days.

Medical follow-up

It is important to keep all scheduled follow-up appointments so that the doctor can ensure that healing is progressing properly. If the child experiences severe pain, swelling, excessive bleeding, or signs of infection, such as fever, it is essential to contact the specialist immediately.

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Conclusion

In short, tongue-tie is a condition that, although it does not commonly cause major problems, can significantly interfere with children's feeding, speech, and quality of life. Fortunately, there are a variety of treatment options. If you think your child might have tongue-tie, consulting a specialist will be essential to evaluate their case and take the necessary measures.