13
2019
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03
Pediatric Science: Should a short tongue tie be cut or not?
The phrase 'as eloquent as a skilled speaker' can be considered a great realm of tongue activity. However, to master this 'skill', mere willpower is not enough; one must also have a nimble tongue. Let's look at the pictures and find out where the secret lies!
Author:
"A silver tongue" can be considered a great realm of tongue activity, but to master this "skill," mere willpower is not enough; one must also have a nimble tongue. Let's look at the pictures and find out where the secret lies?!
Today, our number one female protagonist is her - the "lingual frenulum," commonly known as the tongue tie. It is a thin strip of tissue between the tongue and the floor of the mouth that appears when a child opens their mouth and lifts their tongue. It is a mucosal band formed in the midline of the sublingual area that connects the sublingual area to the alveolar ridge, and everyone has one.
Under normal circumstances, many newborns have their lingual frenulum extending to the tip of the tongue or close to it. During the developmental process after birth, the frenulum gradually retracts backward, so infants cannot move their tongues freely right after birth. Instead, they start with a short tongue that can only suck, and as they drink milk and begin to speak, the tongue tip gradually moves away from the frenulum, leading to normal function.
How to determine if the lingual frenulum is short
Normal lingual frenulum
The tongue moves freely;
The tongue tip can naturally extend outside the mouth in a V shape.
Short lingual frenulum
The tongue cannot normally extend outside the mouth or touch the upper lip when lifted;
When the tongue extends forward, the tip appears indented due to being pulled by the frenulum, forming a W shape.
What are the effects of a short lingual frenulum?
1. If the lingual frenulum is too short during the newborn period, the baby cannot wrap the nipple with their tongue to suck, which may affect feeding.
2. During infancy, if the lingual frenulum is too short, the tongue tip often rubs against the two lower incisors while sucking, leading to ulcers.
3. After the age of 1, during the stage of learning to speak, a short lingual frenulum restricts the tongue's movement in the mouth, affecting articulation and pronunciation, especially for retroflex sounds, palatal sounds, and tongue sounds. For example, difficulties in pronouncing /l/, /r/, and /ch/ in Pinyin can lead to what people commonly refer to as a "big tongue."
4. Additionally, limited tongue movement can also have a certain impact on chewing.
Short lingual frenulum: to cut or not to cut?
1. A small "W" does not necessarily need to be cut. A small "W" indicates that the lingual frenulum is slightly pulled without significant tongue movement, which does not affect the child's ability to suck. As the child grows, some children's tongue tips will gradually move away from the frenulum, not hindering clear speech. It is recommended to observe and follow up before the age of 2. If it affects articulation and pronunciation after the age of 2, surgical intervention can be considered.
2. Children with a large "W" need surgery as soon as possible; otherwise, it will not only affect feeding but also increasingly impact speech.
When to cut? How to cut?
1. For children under 1 year old: the lingual frenulum can be cut without anesthesia or with surface anesthesia. There is little bleeding, the procedure is convenient, and it does not affect feeding. Therefore, the best time for surgery for a short lingual frenulum is before the age of 1.
2. For children aged 1-2 years, it should be considered on a case-by-case basis. At this stage, children have developed self-awareness and have much stronger biting power. If forced, there is a risk of injury. For children over 2 years old, it is recommended to perform the frenuloplasty under intravenous anesthesia.
3. Currently, a common method is to use sterile surgical scissors to cut directly, with local pressure to stop bleeding. This surgical method is convenient and economical, making it a good choice for thin frenula or children under 1 year old, avoiding the risks of general anesthesia. However, this method has a certain rate of postoperative re-adhesion of the frenulum, as the surgical site is exposed, requiring active tongue movement post-surgery to prevent adhesion.
4. Frenulum cutting under intravenous anesthesia with wound suturing and low-temperature plasma radiofrequency ablation frenuloplasty. For children over 2 years old or those with thicker frenula tightly adhering to the floor of the mouth, these two surgical methods are safer and more reliable, with a lower incidence of postoperative adhesion.
Therefore, the choice of surgical method depends not only on age but also on the preoperative evaluation of the thickness of the frenulum and the child's cooperation. If the frenulum is thin and the child is young, direct cutting can be attempted. If the frenulum is thick and there is likely to be significant bleeding during the procedure, or if the child struggles violently, it is safer to perform the operation after intravenous anesthesia.
Is unclear speech related to the lingual frenulum?
As the saying goes, "What crime can one not find a reason for?" Our "lingual frenulum" also has its grievances. Many parents may think of the lingual frenulum when they see their child speaking unclearly. However, a short lingual frenulum only affects the pronunciation of certain words. If a child speaks unclearly or does not speak at all by the age of 2, they should be examined in our ENT department to rule out hearing issues to avoid delaying the child's development.
Note: Although surgery to cut the lingual frenulum has been performed, does that mean the problem is permanently solved? Some children may still have unclear speech after surgery. This is because language expression is a complex process that involves the cooperation of many organs, including the ears, brain, mouth, and nasal cavity. After surgery, children still need speech training, and parents should help correct their pronunciation. In fact, unclear speech is quite common during a child's language development. However, by the age of 4-5, children should be able to pronounce "zh, ch, sh, r" correctly.
If a child's Mandarin is not standard, parents should correct them in a timely manner. They can buy a Pinyin pronunciation chart to teach the child the correct tongue placement when pronouncing sounds. With this understanding, the child will be able to produce standard sounds.
- Warm Reminder -
In summary, whether the lingual frenulum is short and whether it needs to be cut can only be determined by a qualified physician. If you notice any abnormalities, please come to our pediatric outpatient department for a face-to-face consultation with a doctor. Our professional doctors will assess the child's condition in detail and provide the best treatment advice to resolve the child's issues as quickly and effectively as possible.
—END—
Chief Physician of Maternal and Child Health, Song Guangle
Outpatient: Monday to Saturday
Medical Experience:
Graduated from Qingdao University Medical College (formerly Qingdao Medical College) in 1989. Engaged in clinical work for thirty years, currently serving as an associate chief physician and has been the director of pediatrics for many years. Has studied at provincial and municipal top-tier hospitals multiple times, published six academic papers in provincial medical journals, and served as a council member of the Linyi Pediatric Society for two terms.
Specialty:
Currently mainly engaged in pediatric clinical work, especially skilled in the diagnosis and treatment of common and frequently occurring diseases in pediatric respiratory systems and neonatology.
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