Ankyloglosson is a developmental disorder of the tongue that is already congenital. This results in an attached lingual frenulum that affects the movements of the tongue.
What is ankyloglosson?
Ankyloglosson is also known in the medical community as ankyloglossum or ankyloglossia. This is a congenital tongue development disorder in which there is a fixation of the lingual frenulum (frenulum linguae) to the floor of the mouth. Because this disorder limits the mobility of the tongue, affected babies have problems with breastfeeding. In the further course of the disease, there is also a risk of disorders in speech and in the formation of sounds. According to studies, ankyloglossia is responsible for the difficulties of about 16 percent of all babies with breastfeeding problems. Official estimates put the figure at four to ten percent of all babies. In general, however, the number of affected babies is said to be higher than the literature indicates, because in earlier times it was common practice to bottle-feed babies. In this case, the baby is usually not hindered by an ankyloglosson. Because more babies are now breastfed, the shortened lingual frenulum could be detected more frequently.
Causes
The lingual frenulum is a muscular fold covered by mucosa. It provides a connection between the lower surface of the tongue as well as the floor of the mouth. In some babies, the lingual frenulum becomes too short, which in turn has a negative effect on the mobility of the tongue. An ankyloglosson is already congenital. It is unclear what causes this developmental disorder of the tongue. For babies, the frenulum linguae plays an important role in enabling them to take in milk from their mother’s breast. To do this, it is necessary to protrude the tongue over the lower jaw. The baby then makes massaging movements with its tongue, which it uses to push the milk out of the breast. However, if the tongue is strongly anchored in the floor of the mouth, the infant cannot lift it above the lower lip. As a result, the buffer between the groin of the jaw is missing and the baby takes only the nipple into the mouth. The mother, in turn, has the feeling that her child will bite. It is not uncommon for her to experience sore and painful nipples because of this. Because the baby is unable to make the necessary undulating movements and there is no negative pressure, the milk can flow poorly.
Symptoms, complaints and signs
Ankyloglossia is noticeable by a frenulum that is too short and too thick. When the tongue is stuck out, a heart-shaped contour is apparent. In addition, the mobility of the tongue suffers from ankyloglossia. Thus, it is not possible to push the tongue over the lower teeth or the lower lip. In addition, there are restrictions on movements in the upper or lateral direction. Affected babies have problems with breastfeeding because of this. For example, they cannot place their tongue and keep slipping during breastfeeding. For this reason, they want to be fed constantly. In addition, the babies gain weight slowly and not infrequently suffer from colicky pain. Ankyloglosson can exist, however, even if not all of the symptoms described are present. Sometimes, however, these signs show up even when there is no shortened lingual frenulum.
Diagnosis and course
Diagnosis of ankyloglossal frenulum may occur during the U1 examination, which takes place immediately after birth. For this purpose, a doctor or midwife will insert a finger into the infant’s mouth, thereby examining the tongue and palate. However, ankyloglossia cannot be detected immediately in every baby. It is not uncommon for the malformation to become apparent only when problems arise during breastfeeding. Sometimes an ankyloglossia is even not noticed until the child is two or three years old and suffers from speech difficulties. To determine whether there is a shortening of the lingual frenulum, the pediatrician pushes the base of the tongue from side to side using a spatula. If this movement cannot be made, ankyloglossia is present. Ankyloglossia usually takes a positive course. Thus, the treatment, in the course of which the lingual frenulum is cut, is considered simple. Complications are usually not to be feared.
Complications
Ankyloglosson refers to the frenulum, which is shortened from birth. About five percent of all infants are affected.If a newborn is diagnosed with this condition, it is advisable to treat the ankyloglosson quickly. Unnecessary complications are avoided, which otherwise have a significant impact on the child’s language acquisition and healthy development. The shortened ankyloglosson affects the mobility of the tongue. In addition, breastfeeding the baby proves to be unfeasible. It can neither suck nor swallow sensibly. The infant is at risk of colicky pain and rapid weight loss. If the ankyloglosson is not corrected, the position of the tongue changes completely and there is an additional risk of malpositioning of the teeth. Likewise, later in the child’s speech, the infant is unable to utter many sounds. The tongue appears to be rigid. Often, mouth breathing occurs as a consequence, which increases the susceptibility to infections. If the maldevelopment is less pronounced, intervention should still be performed before the child starts school. As the child grows up, unpleasant problems can arise at the latest with braces, tongue piercing or kissing. If the person has had an accident or lost teeth at an early age, it is difficult to adjust a dental prosthesis. On the other hand, the surgical intervention to correct the malposition of the lingual frenulum is risk-free.
When should you go to the doctor?
Ankyloglosson does not necessarily need to be treated by a doctor. However, if the shortened lingual frenulum causes pain or other discomfort, medical help is needed. Parents should see a doctor if the infant has trouble breastfeeding and shows signs of colicky pain. If the affected infant is not eating enough due to the discomfort, the pediatrician must be informed. The physician can usually diagnose the ankyloglosson beyond doubt by examining the tongue and palate and suggest surgery. Sometimes, however, the shortened lingual frenulum is not noticed until the second or third year of life. Medical clarification is necessary if the child has problems speaking or shows signs of pain. At the latest, if malocclusions are detected, the child should be taken to the doctor. In less severe cases, the affected child can have the ankyloglossia clarified later in life. This is necessary, for example, if kissing, tongue piercing or braces cause problems. Correction of the lingual frenulum can be performed at any age and is usually risk- and pain-free.
Treatment and therapy
Treatment of ankyloglossal frenulum consists of surgical transection of the attached lingual frenulum. The procedure is considered useful when the baby suffers from breastfeeding problems and speech disorders are imminent. In other cases, however, the procedure is performed only when speech problems actually occur in the affected child. Ankyloglossia does not always require therapy. This can be omitted if the frenulum does not cause any problems. Ultimately, the extent of the symptoms determines whether treatment is necessary. However, according to experts, this should be done at an early stage if the tongue can only be moved to a limited extent. An operation on the frenulum takes about 20 to 25 minutes. If necessary, the child receives a short general anesthesia. If this leads to risks, the operation must be postponed. During the procedure, the doctor first pulls the tongue upwards. Next step is cutting the frenulum of the tongue with a short incision. After that, the suturing of the wound with sutures that dissolve themselves takes place.
Outlook and prognosis
The prognosis for ankyloglosson can be considered very good. In a short surgical procedure lasting only a few minutes, the attached lingual frenulum is cut under general anesthesia. The wound in the mouth is then adequately treated so that it can heal completely within a few days. Normally, the patient is then considered to be symptom-free and permanently healed. If complications occur in advance, the healing process may experience delays. In the event of drastic weight loss, this must first be gradually built up again in the coming months after the operation. Depending on the child’s personality and behavior, this may take some time, a lot of patience and perseverance. If the child has developed fears, these must be reduced and new confidence in eating must be built up. In rare cases, general anesthesia can cause secondary symptoms. These also prolong the healing process.Reactions of intolerance due to the given medication may occur or sleep disturbances may set in. The complaints are of a temporary nature in most patients. However, they are usually completely cured after a few weeks. Breastfeeding difficulties are to be expected even after the corrective surgery. The prognosis for possible breastfeeding after the surgical procedure is less optimistic. The infant is therefore switched to feeding on substitutes at a very early stage.
Prevention
It is not possible to prevent ankyloglosson. Thus, it is a congenital developmental disorder.
Aftercare
Options for aftercare are not available to the person affected by an ankyloglosson. However, these are also not necessary, as the condition can be treated by surgery, and there are usually no special complications or other difficulties. The disease can be completely treated by the surgical intervention, and the patient’s life expectancy is also not negatively affected by it. After the operation, the patient must rest and take care of his body. In most cases, a complete recovery is achieved quickly, so that a long stay in the hospital is not necessary. The stitches also usually dissolve by themselves and do not need to be removed. Since the ankyloglosson is usually removed at a young age, parents often try to reassure the child and ease his or her fear of the operation. Since the symptoms can also lead to psychological upsets or depression, discussions with the parents and relatives are very useful in this regard. Contact with other patients affected by ankyloglosson can also have a positive effect on the course of the disease. The earlier the disease is treated, the better complications can be avoided.
What you can do yourself
Ankyloglosson can be treated easily and without complications nowadays. Patients should follow the doctor’s instructions after the ankyloglossal frenulum is surgically cut. The medical professional will recommend an adjusted diet without irritating or spicy foods. Caffeine, alcohol and nicotine should also be avoided initially to prevent the surgical wound from becoming infected. An appropriate light diet is also recommended before the operation. If any problems occur after the operation, the doctor must be informed. Parents who discover an ankyloglosson in their child should have it removed while the child is still a newborn, if possible. If speech problems have already developed, they must be corrected with the help of a speech therapist. Since the removal of an ankyloglosson is a routine procedure, no further measures are necessary. After the procedure, rest and relaxation apply for a few days. Aftercare is limited to a check-up by the primary care physician, who will inspect the site of the procedure. In case of pain or swelling, general measures such as applying a cold pack will help. During the first few days, care should be taken with oral hygiene so that the wound is not injured and accidentally opened.
