The Frenulum Linguae arises from a thickening of the genioglossus muscles meeting in the midline of the tongue to form a vertical fold. Tongue tie ranges from only a mucous membrane band to a fibrous frenulum and genioglossus muscles, and even fusion of the tongue to the floor of the mouth. The tongue is always short at birth, but as the infant grows it becomes longer and thinner towards the tip until eventually the frenulum is well behind the tip. Many mothers ascribe their child’s feeding difficulties, lateness in speaking or indistinctness of speech to tongue tie. This diagnosis is almost invariably wrong.
Some think that if the child is unable to protrude the tongue or to touch the palate with it, he may have difficulty in pronouncing ‘N’, ‘L’, ‘D’, ‘T’ and ‘Th’, especially if the palatal arch is high. It has been said that intelligent, emotionally stable healthy people can overcome such a slight physical handicap without operation or speech therapy. It is easy to ascribe indistinctness of speech to tongue tie when it is due to other causes.
According to the Illingworth, Sheffield, 1982, ‘I have never seen feeding difficulties in the first year resulting from tongue tie and I doubt whether it is ever necessary to carry out an operation on it till the age of two or three’. The operation should not be performed if the tongue can touch the palate.
A guide to the severity of the tongue tie is a deep midline depression at the tip and the child’s inability to lick his upper lip. There are still doctors who cut the frenulum in the newborn period. This is always wrong. It may cause hemorrhage from the profunda linguae vein and infection may complicate the operation. The operation in the newborn period is due to ignorance of the normal appearance of the tongue of the newborn. If it has to be done at all, the operation should be done by a pediatric or plastic surgeon when the child is 2 or 3 years old
Written By: Dr. Harman
Edited By: C. Soni