Overview
Tongue tie, characterized by an abnormally short or tight lingual frenulum, can affect breastfeeding in infants and speech clarity in children and adults 12.Diagnosis
Clinical Examination: Identification of a heart-shaped lingual apex, frenulum fixed in the upper third of the tongue, and restricted tongue protrusion 1.
Functional Assessment: Evaluation of tongue mobility, including descent at rest, restricted protrusion with clicking sounds, inability to achieve attachment or vibration, and articulation issues (e.g., distortion of /r/ and /rr/ sounds) 1.
History: Presence of breastfeeding difficulties, preference for soft foods, and speech problems in older children 12.Management
Surgical Intervention: Frenuloplasty or frenotomy indicated for significant functional impairment 12.
Speech Therapy: Recommended post-surgical to optimize tongue function and speech outcomes 1.
Pain Management: Use of glucose/sucrose drops, topical lidocaine, or no specific pain control measures during the procedure 2.
Post-Procedure Care: Continued lactation support, wound massage/stretching, or no specific post-procedure care recommendations vary 2.Special Populations
Pediatrics: Primary indications include breastfeeding difficulties and latch issues in infants, speech difficulties in older children 2.
Adults: Management focuses on functional impairments affecting speech and oral habits, though specific guidelines are less detailed 1.Key Recommendations
Surgical Evaluation and Intervention for infants with significant breastfeeding difficulties and older children with speech impairments (Evidence: Moderate 12).
Integrate Speech Therapy post-surgery to enhance tongue function and speech outcomes (Evidence: Moderate 1).
Consider Pain Management Strategies during frenotomy, including topical anesthetics or sucrose drops, based on clinical judgment (Evidence: Weak 2).References
1 Palomares-Aguilera M, Inostroza-Allende F, Álvarez Carvajal D, Villena Balcázar C, Goldschmied Aljaro K, Castellón Zirpel L et al.. Surgical and Speech Therapy Evaluation of Lingual Frenulum. The Journal of craniofacial surgery 2023. link
2 Dhir S, Landau BP, Edemobi S, Meyer AK, Durr ML. Survey of Pediatric Otolaryngology Frenotomy Practice Patterns. The Laryngoscope 2022. link