TONGUE-TIE

Objective: To review the presenting features of tongue-tie in childhoo d and indications for frenulotomy, drawing conclusions from a retrospe ctive study of patients encountered in paediatric surgical practice an d from the literature. Methodology: A disease index was kept enabling histories to be selected for analysis. All patients were seen by the a uthor and all operations performed by the author or a registrar under supervision in a standard manner. Patients were reviewed 2 weeks after operation. Results: During 18 years of practice, 287 patients with si mple tongue-tie were encountered (two others with true ankyloglossia w ere not included in this study) and 158 frenulotomies were performed. The presenting symptoms were related to sucking or swallowing (13%), s peech (32%), mechanical problems related to restricted tongue movement s (14%) and to other problems (3%). In 38% the asymptomatic tongue-tie was noted incidentally. Conclusion: It is concluded that there is no place for division of tongue-tie without anaesthesia in the newborn. S peech difficulties related to tongue-tie are over-rated and mechanical problems are underestimated. The indications for frenulotomy include articulation difficulties confirmed by a speech pathologist, mechanica l limitations such as inability to lick the lips, to perform internal oral toilet or play a wind instrument. There may be rare instances in infancy where problems with feeding and suction can be helped by frenu lotomy but evidence for this is anecdotal. Operation requires general anaesthesia except in older, cc-operative teenagers in whom local anae sthetic is appropriate.