AboutFace

Orofacial Myofunctional Therapy

Ankyloglossia

Ankyloglossia is often referred to as “tongue tie”, and it is described as an abnormal shortness of the frenum located under the tongue, limiting the tongue’s movement. It can interfere with oral development, feeding, speech and swallowing and can create associated problems. Ankyloglossia affects males more often than females (3:1 ratio).

When you open your mouth and elevate the tip of your tongue, you can clearly see your lingual frenum (also referred to as a frenulum); the little “cord” that attaches your tongue to floor of your mouth. In some cases, the frenum might be visible but too short to allow full tongue movement. In other cases, the shortened frenum might not be visible at all, and is then defined as submucosal ankyloglossia.

Normal Range of Motion

Greater than 1.5 inches or 16mm

Class I - Mild

12-16mm

Class II - Moderate

8-12mm

Class III - Severe

4-8mm

Class IV - Complete

0-4mm

How is ankyloglossia classified?

The severity of ankyloglossia can be classified using various assessment tools. The Kotlow assessment tool categorizes ankyloglossia into four categories or classifications based on the length of the free tongue (the distance from the tip of the tongue to the attachment of the frenum). A distance of greater than 16mm is considered clinically acceptable.


Why be concerned with ankyloglossia?

Ankyloglossia can seriously affect people’s health at any age. To experience what ankyloglossia feels like, try to talk and eat while keeping your tongue on the floor of your mouth. You can see it is challenging!

In infants: ankyloglossia can be associated with breastfeeding difficulties, failure to thrive and difficulty with the introduction of solid foods.


In children: associated with “sloppy” eating secondary to difficulty chewing the food and moving it in the mouth, impaired articulation, poor oral hygiene, dental problems (incorrect teeth eruption or the rotation of bottom teeth inward), change in the development of the face and jaw, and importantly, strong emergence of compensatory incorrect habits such as a tongue thrust.

In adults: associated with continued misarticulation of sounds, clicking or pain in the jaws, migraines, obstructive sleep apnea, effects on social situations (eating out, kissing, relationships) and dental health (inflamed gums, crowding, cavities, extractions).


How can we treat ankyloglossia?

Once a tongue tie has been diagnosed, a recommendation may be made to have the lingual frenum released through a frenectomy; also known as a frenulectomy or a frenotomy. It’s a simple procedure that uses local anesthesia to remove the frenum. It lasts generally 5 minutes using a scalpel or a laser. A laser is usually the preferred approach as it causes little bleeding, requires no sutures and causes very little post-procedure discomfort.

What is the role of the Orofacial Myologist?

It is strongly recommended that you consult with an orofacial myologist before your surgery. Pre-procedure, the orofacial myologist will assess your tongue tie and your function and will provide a personalized pre-op therapy plan to get you ready for your procedure. Without proper preparation, the release of your tongue tie may not be complete resulting in the inability to restore optimal function to the orofacial complex. The only true remedy, if this were to happen, would be to have the release done again.

Post-procedure, the orofacial myologist prescribes home-based daily exercises to avoid scarring; ensuring the tongue remains long and flexible. Once the frenum is released by the surgeon, the tongue will be able to freely move around the oral cavity.

The muscles of the tongue will be unable to perform their proper functions from being anchored to the floor of the mouth. Specific exercises are given to restore the muscles of the tongue to assist the tongue moving vertically and achieving appropriate tongue resting postures. Achieving appropriate tongue resting posture, function of the muscles as a unit and recapturing the dental freeway space is essential.

Your orofacial myologist can help to eliminate a tongue thrust that may

accompany a restricted lingual frenum. Improved chewing and swallowing skills are important for a person of any age.

Furthermore, the incorrect speech patterns, incorrect tongue placement at rest and swallowing functions will likely not correct themselves. Over the years, individuals with ankyloglossia develop strong abnormal habits to compensate for the tongue being attached on the floor of the mouth. A habit is not something easy to change, and most people do not know what the correct position should be. An orofacial myologist experienced with resting tongue posture can help you with learning correct placement for articulation, at rest, and while eating, drinking and swallowing.