Disease Description (Causes and Symptoms)
- Definition: A condition in which the lingual frenulum beneath the tongue (the tissue connecting the tongue and floor of the mouth) is short or lacks elasticity, restricting tongue movement (Ankyloglossia, tongue tie).
- Causes·pathophysiology: Usually a congenital developmental defect and, rarely, may occur after surgery or trauma. When the lingual frenulum is short, forward elevation and protrusion of the tongue are restricted, affecting latching, pronunciation, and oral hygiene.
- Main symptoms: Feeding difficulties in infants (poor latching and maternal nipple pain), a W-shaped appearance of the tip of the tongue, pronunciation errors (especially ㄹ, ㅅ, ㅆ, ㅈ, ㅊ, etc.), and bad breath due to the accumulation of tongue coating in the mouth. Diagnosis is mainly made by visual examination (observing resistance when the tongue is lifted and the shape of the tongue tip).
Treatment Methods
- Non-surgical management
- For young infants, attempts may be made to improve symptoms through correction of breastfeeding positions, use of feeding aids, and breastfeeding counseling (feeding specialist or breastfeeding coaching).
- For pronunciation problems, speech therapy (evaluation and rehabilitation by a speech-language therapist) may be provided concurrently.
- Surgical treatment
- Frenotomy (simple incision): A simple procedure in which the sublingual membrane (lingual frenulum) is incised. It can be performed relatively easily in newborns and infants.
- Frenuloplasty (including modified closure): Tissue is repositioned and sutured with absorbable thread to relieve tension and reduce reattachment. It may be selected for older patients or when the tissue is thick.
- Anesthesia: In newborns, it can generally be performed under local anesthesia or as a brief procedure; for longer surgery or in children and adults, local or general anesthesia may be considered.
- Medication and postoperative care
- Pain control (mild analgesics), wound care, and observation for signs of infection.
- Guidance on tongue exercises (stretching) and oral exercises to prevent reattachment.
- Postoperative speech therapy and breastfeeding/feeding retraining when necessary.
- Precautions (points to note)
- Possible bleeding, infection, pain, scarring during the healing process, and nerve damage during surgery.
- The decision to undergo surgery should be made after consultation with a specialist, taking into account the severity of symptoms, age, and the extent of feeding and speech problems.
- Speech therapy may still be necessary to improve pronunciation after surgery.
- Complications
- Bleeding, infection, scar formation, reattachment (recurrence), delayed healing, and, rarely, nerve damage.
- Prognosis
- With appropriate treatment and rehabilitation, feeding, tongue movement, and pronunciation improve in most cases. The prognosis is good with early diagnosis and treatment.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items and information to prepare
- A list of currently used medications (including feeding-related medications for infants and young children).
- Information about previous surgeries, medical history, and allergies.
- The onset, frequency, and severity of feeding and pronunciation problems (e.g., feeding duration, how the infant sucks, and changes in breast milk or formula intake).
- A video recorded during feeding (a feeding scene recorded by the mother or caregiver), and photos or videos showing the shape or movement of the tongue.
- Previous relevant test results (if applicable).
- Items that may help explain symptoms during the appointment (example questions)
- How much is the baby unable to eat during feeding? (Feeding duration and weight-gain status)
- What problems are there with pronunciation (or speech development)? When were they first noticed?
- Parents’ expectations if surgery is desired (improved feeding, improved pronunciation, etc.)
- Whether breastfeeding support education or speech therapy has been received previously
Examples of General Questions to Ask the Doctor
- What are the advantages and disadvantages of this surgery (procedure)? How likely are side effects?
- In our (child’s) case, is there a possibility of improvement without surgery?
- What type of anesthesia will be used for the procedure, and how safe is it?
- How will pain be managed after surgery, and how long is the recovery period?
- How likely is recurrence (reattachment) after surgery, and how should it be managed if it recurs?
- If speech therapy or feeding retraining is needed after surgery, when should it begin?
Examples of Condition-Specific Questions
- To what extent can the baby’s feeding problems be improved by surgery? (e.g., expected improvement in weight gain and breast milk intake)
- Could you explain the specific exercises (stretching) and home-care methods for preventing reattachment after surgery?