Ankyloglossia, also known as tongue-tie, is a congenital oral anomaly caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth, which may decrease tongue mobility (Figure 1).
Figure 1.
Anterior tongue tie
Rates of ankyloglossia appear to have increased dramatically from 6.86 to 22.6 per 1,000 live births between 2002 and 2014 (1). It is perceived as an addressable barrier to breastfeeding with 63.9% of infants with this diagnosis receiving frenotomy, rates which also increased from 3.76 to 14.7 per 1,000 live births (1). Indication for frenotomy does not always follow standardized criteria such as the Hazelbaker assessment (2). A holistic professional feeding assessment by a health care professional trained in lactation support is advisable, to address any other concomitant feeding barriers and ensure adequate follow-up.
With higher prevalence of infants postfrenotomy, there may be implications for health care providers in the community such as mild irritability, bleeding and pain in the immediate period, or being faced by the unexpected finding of a torn frenulum (Figure 2).
Figure 2.
Baby after 24 hours post frenotomy
A torn frenulum on physical exam without frenotomy history in a small infant should raise suspicion of potential physical abuse. The implicated mechanism is forceful feeding or shoving a soother forcefully into the baby’s mouth. Torn frenula do not seem to have a good predictive value in isolation, but thorough physical exam for other signs of abusive injury and psychosocial evaluation of these families is indicated (3). While in a specialized paediatric emergency setting, the potential abusive implication of a torn frenulum may be recognized, in a more rural or less specialized setting, this association may not be as evident. All health care providers should be aware of the potential for abuse with this type of injury and should report any concerns to child protection services.
Funding: Nothing to disclose.
Conflicts of Interest
None for any authors.
References
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