Normal tongue mobility is an important
factor in speech development. However in a newborn it is also essential for
breastfeeding. Unfortunately, it is not uncommon that a child is born with a mucosal flap
under the tongue tip causing a relative immobility leading to breastfeeding
difficulties. This is known as tongue tie. The tongue tie can be either easily
visualized as shown here or hidden under the mucosal lining. When hidden under the
surface, it is known as posterior tongue tie. Regardless of what type of tongue
tie, symptoms a mother may experience include prolonged feedings, painful nipples, and
decreased milk production while infants may exhibit noisy suckling and gas pains.
Given how small an infant mouth is, the following footage was obtained in an
adult for illustrative purposes. Steps are identical in newborns however. Note
how the posterior tongue tie which is hidden under the surface causes the
mucosa to tent up. After numbing medicine is injected into the area, a device
is used to incise the mucosal surface. Dissection is
carried out into and through the tongue tie thereby releasing the tongue. It is
important that the dissection be carried down to but not thru the muscle for full tongue
release to occur. Once completed, one can actually see the muscle fibers. A fast
absorbing suture is then placed to close the wound to prevent scarring as the
area heals. This suture typically dissolves away within a week.
If the wound was left open without a stitch, there is a high risk the
posterior tongue-tie will recur due to scarring. With closure, this risk is
minimized. Note how the initial incision was
horizontal but the suture is placed such that the wound is reoriented vertically.
By reorienting the incision from a horizontal to a vertical position, the
tongue tip is further lengthened.