The child has just started forming words but "la" and "ra" sound strange while for another little one the ice cream cone looks yummy, but he cannot stick his tongue out and take a lick.
Why? Tongue-tie or ankyloglossia, as it is known medically, is the problem.
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| Dr. A.D.K.S.N. Yasawardene |
This is a congenital (present at birth) oral anomaly which affects the mobility of the tip of the tongue, says Consultant ENT Surgeon Dr. A.D.K.S.N. Yasawardene of the Lady Ridgeway Hospital for Children in Colombo. "It is caused by an unusually thick and short lingual frenulum, the membrane that connects the underside of the tongue to the floor of the mouth."
In severe cases the tongue is tethered to the floor of the mouth, MediScene learns, with more boys than girls being prone to this.
With many schools of thought whether tongue-tie is a problem or not, Dr. Yasawardene says that diagnosis could also come at various stages. Some babies are spotted with tongue-tie during the very first medical examination at birth while others go undetected for life if there is no apparent problem. Meanwhile, other children may be diagnosed with tongue-tie when they are two or three years old when they develop feeding or speech issues such as inability to articulate certain sounds.
What of the treatment which is also caught up in controversy?
One school of thought is that it could be left alone until the baby develops speech (12 to 18 months of age). "If the child has a problem after that, surgery is considered," says Dr. Yasawardene, adding that at the ENT Unit of the LRH they carry out about one or two operations every month to correct tongue-tie.
This is done in consultation with a speech therapist who would advise whether the tongue-tie is hindering the child's speech, it is understood.
Sometimes children with tongue-tie could also face ridicule and the operation may be done to overcome the deformity and improve the cosmetic effect.
If an operation, a frenulotomy, is needed, a paediatric surgeon would divide the frenulum from the base of the mouth with a pair of scissors, he says, adding that in some countries like England and India it is done when the child is tiny (<6 months) without even administering anaesthesia. "Although the procedure is simple and takes the form of snipping the skin to divide the frenulum from the bottom of the mouth, at LRH we don't do it without anaesthesia," he says.
The procedure takes only a few seconds and there have been no significant post-operative complications in cases done at the LRH. There is an improvement in a large number of children who undergo this operation.
If by chance, as happens in a small percentage, there is a recurrence causing tongue adhesion once again after the procedure, then a frenuloplasty is performed, where a wedge is cut out from the frenulum and then sutured, Dr. Yasawardene adds. |
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