Adult with ankyloglossia

Essentials

  • Ankyloglossia (a tongue-tie) is usually diagnosed and treated in childhood.
  • Nevertheless, ankyloglossia may also be encountered in adults, in which case the tight lingual frenulum can be incised (frenotomy) under local anaesthesia.

Symptoms

  • A tight lingual frenulum may make it difficult to raise the tongue to the anterior palate thus hampering the making of certain sounds (e.g. D, T and S).
  • A patient with a tight lingual frenulum may also be unable to protrude the tongue outside the mouth making licking difficult.
  • In some cases the restricted mobility of the tongue may even affect oral hygiene.

Examining the patient

  • The lingual frenulum is too tight if
    • the frenulum is thick
    • on protrusion, the tip of the tongue becomes notched in midline
    • restriction on tongue movement is observed due to the above-mentioned reasons.

Treatment

  • A tight symptomatic lingual frenulum can be incised (frenotomy) under local anaesthesia.
  • After the local anaesthesia has been applied, the lingual frenulum is incised near the inferior surface of the tongue taking care not to damage the openings of the submandibular gland, situated on either side of the lingual frenulum in the anteroinferior aspect, or any of the veins situated under the tongue.
  • The procedure is often almost bloodless, and sutures are not necessarily needed.
  • The mobility of the tongue should be actively promoted after frenotomy by doing extensive tongue movements during the mucous membrane healing period (about 1 week).

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