Background: Tongue tie or ankyloglossia is a well recognized congenital anomaly of the tongue. It results from a restriction or lack of development of the lingual frenulum which is a membranous attachment from the underside of the tongue to the anterior floor of the mouth. When the frenulum is short the tip of the tongue’s motion is limited, often not allowing the tongue to move past the edges of the lower teeth.
There are numerous potential functional limitations from a severe tongue tie from eating, speech and dental development. While somewhat controversial for some, a tongue tie release or ankyloglossia surgery is often done early in life to give the tongue full range of motion and to prevent any subsequent functional limitations. This procedure of often combined as part of other minor surgeries as it requires an anesthetic given the very young age of the patient.
Seeing an adult with a significant tongue tie is rare since they are almost always released early in life. The main reason an adult would finally release it is if they desired greater tongue mobility, particularly that of tongue protrusion. This can translate into an improved ability to clean the teeth with tongue during and after eating. The second benefit would be an improved ability to use the tongue during intimacy.
Case Study: This 24 year-old female had long wanted to have her congenital tongue tie released. She has never been able to stick her tongue out and had always felt her ‘forked tongue’ was unusual.
Under local anesthesia, her tongue tie was released at its base just behind the sublingual ducts. It was released by needlepoint electrocautery back along the floor of the mouth to the base of the tongue. In a near V-Y mucosal closure pattern, the mucosal edges were closed with small dissolveable interrupted sutures. The increase in her tongue’s range of motion was immediate and considerable as can be seen in the above before and after pictures.
Tongue tie release in adults is just as effective in adults as in babies and infants. Its effects are immediate and there is little if any recovery from this simple floor of the mouth procedure.
Case Highlights:
1) Significant tongue tied in adults is fairly rare due to its tongue mobility restrictions and earlier treatment for release.
2) Tongue tie release surgery in adults can be done under local anesthesia as an office procedure in adults.
3) The simplest and most effective tongue tie release surgery is a V-Y advancement technqiue.
Dr. Barry Eppley
Indianapolis, Indiana