TIED TONGUE:
When does it appear and why is treatment unclear?
Diagnosis :
Tied tongue is an anatomical variation in which the tongue is attached to the gums of the lower jaw instead of to the floor of the mouth.
Diagnosis is usually made within the delivery room at the time of the first physical examination, or later by a lactation consultant or a speech therapist.
In cases where there is a functional disorder in breastfeeding or speech as a result of the associated tongue attachment, it will be suggested that the tongue is disconnected at its base - an operation called a lingual frenectomy.
During the procedure the surgeon releases the connection between the tongue and the floor of the mouth in order to allow the tongue the mobility it needs to function properly.
Therapeutic considerations :
Historically, treatment of a tied tongue is performed by physicians from different disciplines - pediatric surgery, ENT, as well as Oral and Maxillofacial surgery - and this may be the reason for the lack of an unambiguous treatment protocol. It is not uncommon to hear diverse opinions from various physicians regarding the indications for treatment.
The dilemma stems from the fact that on the one hand as the detachment of the tongue takes place closer to the day of birth the treatment and recovery are likely to be simpler, yet on the other hand sometimes the need for treatment is not unequivocal at such an early stage of life.
There is no arguing that not every tied tongue requires surgical intervention. There are cases where the tongue will release itself spontaneously over time, there are tongues that will be able to function well despite their limited anatomy (e.g. with the help and care of a lactation consultant), and there are tied tongues that will not interfere with proper speech.
Treatment :
The age of the patient, the anatomy of the tongue and the degree of disability of the movement will dictate the need for anesthesia for the purpose of treatment. (Babies up to several weeks of age usually do not need to be given any medication for this treatment.)
After releasing the bottom part of the tongue, slight pressure is needed to stop the bleeding and in rarer cases also in a number of absorbable sutures.
While infants do not need painkillers or special instructions, older patients may have local pain and swelling that will go away after a few days.
It is recommended to move the tongue as soon as possible to prevent reconnection and reconnection of the detached tongue.
Complications such as bleeding and infection are possible after a frencatomy, but these are extremely rare symptoms.