Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
TONGUE – TIE
• Anatomical
– Type 1
• Frenulum attaches to tip of tongue in front of alveolar ridge in low lip sulcus
– Type 2
• Attaches 2-4mm behind tongue tip and attaches on alveolar ridge
– Type 3
• Attaches to mid-tongue and middle of floor of the mouth, usually tighter and less
elastic. The tip of the tongue may appear ―heart-shaped‖
– Type 4
• Attaches against base of tongue, is shiny, and is very inelastic
Symptoms
• Babies
– Lift baby's tongue and examine lingual frenulum. The lingual
frenulum may be thick or thin and may extend to the tip of the
tongue.
– Measure the strength of baby's suck by inserting a finger into the
baby's mouth and noting how hard he or she sucks on it.
– Weigh baby and determine whether he or she weighs less than
expected.
– Ask whether mother have sore nipples.
– Watch mother breast-feed to see how well the baby latches on and
sucks.
• Older children or adults
– Examine the mouth for:
• Restricted tongue movement :
– Measure the tongue's protrusion beyond the lower teeth.
– This measurement may be used as a comparison after tongue-tie surgery.
– Looks for difficulty lifting the tongue to the upper teeth and upper lip
– Look for limited side-to-side tongue movement.
• Abnormal spacing between the front lower teeth.
– Caused by rubbing of the lingual frenulum during protrusion of the tongue.
• A notched or heart-shaped tongue when protruded.
• The tongue may roll or curl when the person tries to protrude it.
• Other tests
– Lactation consultant
• If primarily having breast-feeding difficulties
• May be able to help teach the mother how to assist her baby in latching on and sucking effectively.
– Speech therapist
• If speech problems
• To rule out other conditions that could be causing the speech problem.
Management
Conservative
• Breast feeding advice and counselling
• Controversial.
• Some experts believe that surgery should be done before
speech problems develop.
• Others believe that surgery should be delayed until the child
is 4 years old and should be done only on children with
speech difficulties.
• But delaying surgery may result in the child needing speech
therapy after surgery to correct any altered speech patterns.
Surgery Options
• Frenotomy
— No anesthetic needed
— No suturing
• Frenectomy
— Local or general anesthetic used
— Sutures placed
• Z-plasty
— More complex
— Sutures placed
Frenotomy technique