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Being tongue-tied is a common phrase that implies one can not speak due to a loss of words. But being tongue-tied is also a real medical condition that is a well known congenital oral defect known as ankyloglossia. It occurs when the attachment of the tongue (lingual frenulum)) is unnaturally short.

The lingual frenum is a web of mucous membrane that connects the underside of the tongue to the front of the floor of the mouth at the locations of Wharton’s ducts. During fetal development the lingual frenum serves to keep the tongue fixed into position as it grows forward as the oral structures around it form. If some abnormality of the frenum occurs during this process, the frenum remains short and its lack of adequate length is evident at birth. Very short frenulum attachments can cause numerous functional problems with speech, feeding and oral hygiene/function.

Surgical release of short lingual frenum is known as a frenoplasty. There are debates as to when this procedure should be done if needed. But when it is done the technique of doing it remains the same. In infants and children the procedure is done under a limited general anesthetic. The frenum is incised with a needlepoint electrocautery at its tightest point on the underside of the tongue. With the tongue on stretch, the release is performed until the tip of the tongue can be brought well past the incisal edges of the lower teeth. This v-shaped release is then closed as a linear line with an elongated undersurface of the tongue with small resorbable sutures.

The lingual frenuloplasty is an uncomplicated procedure that its highly effective and has a short operative time. Its only potential complications are disruption of the salivary ducts or the lingual veins, both of which are easily avoided.

Dr. Barry Eppley

Indianapolis, Indiana

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