TONGUE TIE IN INFANTS
Dr. Vivek M. Rege
Pediatric Surgeon & Pediatric Urologist
B J Wadia Hospital For Children, Hurkisondas Hospital, Wockhardt Hospital, Mumbai
Inability to protrude the tongue in an infant or child is something that is easily noticed by the parents of that child. This condition is called a tongue tie and is caused by a short frenulum or attachment of the tongue to the floor of the mouth. In these children, the defect may be noticed soon after birth or later. The reason for delay in picking up this condition is because there is no specific symptom associated like pain or difficulty in taking feeds or swallowing and sucking. Thus, the parents may see the anomaly much later. The parents may notice this either because they find the shape of the tongue to be abnormally flat and rounded rather than the typical sharp narrowing towards the tip, or because the child at one year begins to talk with a persistent lisp, or there is a delay in speech. In fact, this anomaly of tongue tie will never be the cause of delay in speaking or in the speech with a lisp. The only problem with speech in a child with a tongue tie is that since the tongue is not mobile, the tip cannot reach the palate on top and henc the hard consonants like t, d, dh etc may not be pronounced properly. However, delay in speech or lisp is never the result of the tongue tie and the parents have to be clearly made aware of this fact. After correction or release of tongue the speech may not begin or be corrected forthwith but will require the help of speech therapist for some time to get the muscles of the tongue working properly.
Ideally, the corrective surgery for this condition should be done after the child has reached the age of 1 year and has begun to talk. This is usually done as a day care case, when the child is brought to the hospital in the morning and is operated early. The child can be sent home the same evening or night after confirming that there is no bleeding. The surgery is done under general anesthesia. The mouth is opened and the short frenulum is seen, and is cut towards the tongue carefully to avoid injuring important structures nearby. After this has been done, the tongue can be brought out easily but the area where the cut has been taken may bleed and hence multiple absorbable sutures are taken. The child will come out of anesthesia after 3 hours, when sips of water is given and later only liquids are allowed to be taken for the next 4 days. This is to ensure that no food particle may rub against the suture line and start a bleed. After 4 days gradually soft diet is introduced and finally within a week the child may be on a regular diet as before. Postoperative follow up will be necessary for about a month. In some of the children with severe speech defect that is in no way connected to this defect, they will need to se a Speech Therapist for further treatment.
Tongue cannot be protruded out as there is a tight frenulum (arrow)
After release of tongue tie
Last Updated: 27th January 2009