The estimated prevalence of ankyloglossia varies widely depending on the diagnostic criteria and the patient population studied. Systematic reviews report an overall prevalence of approximately 5%, ranging from as low as 2% with nonspecific tools to up to 20% when using the Coryllos classification. 

The highest rates are observed in infants (7%) and exhibit a slight male predominance. There is no standardised diagnosis or universally recognised classification of ankyloglossia, and systems such as Hazelbaker, Coryllos, Kotlow, or ATLFF (Assessment Tool for Lingual Frenulum Function) are used, but none of them correlates perfectly with the severity of the symptoms. 

You must be aware of the causes, symptoms, diagnosis, and treatment of ankyloglossia in case you are studying to appear in NEET PG.

Keep reading to know more!

What is Ankyloglossia?

A defect of the lingual frenulum is called ankyloglossia or tongue-tie, which is a reduced mobility of the tongue. In a person with this condition, the frenulum is abnormally short, thick, or tight and thus can severely limit movement of the tongue.

The level of constriction differs and may affect the fundamental oral functions of an individual. Tongue-tie can complicate breastfeeding in infants, where it can result in poor attachment, lack of milk transfer, or sore nipples in the mother. In the cases of older children and adults, it can cause deterioration in articulation, swallowing, or the possibility of backwards protrusion of the tongue below the lower teeth. 

What Causes Ankyloglossia?

Tongue-tie is a congenital condition that is present at birth. Even though the exact cause is not yet clear, there is evidence that genetic factors can also be involved. It has been shown that sometimes tongue-tie can be an inherited trait and may have an X-linked pattern of inheritance.

What are the Symptoms of Ankyloglossia?

Ankyloglossia symptoms in newborns are as follows:

1. Difficulty in Latching:  The baby will refuse to latch on to the breast, will be crying when trying to latch, will click its tongue, or will keep falling off the breast.
2. Sluggish Milk Transfer: Can cause infrequent weight gain, even frequent feeding, or a lack of swallow sounds during breastfeeding. 

Breastfeeding symptoms experienced by mothers may include:

1. Cracked or painful nipples.
2. Discomfort or pain while nursing.
3. Low milk supply (especially if poor milk transfer continues over time).

These signs are nonspecific, meaning they can also be caused by issues other than tongue-tie. It’s essential to consult a healthcare professional who is experienced in breastfeeding challenges to determine the exact cause and appropriate treatment.

How to Diagnose Ankyloglossia?

Ankyloglossia diagnosis involves the following steps:

1. Initial Assessment by Paediatricians and Lactation Consultants

Tongue-tie can be detected early when a child is born, and its diagnosis is usually made by the paediatrician in conjunction with a lactation consultant. 

2. Anatomical Variation vs. Functional Limitation

A short or tight lingual frenulum is not an indicator of clinically significant tongue-tie in all infants. The diagnosis can only be carried out in cases where there is a restrictive frenulum and when there is an obvious limitation in tongue movements.

3. Diagnostic Process 

• Review of Breastfeeding History: Providers will question you about your experience with breastfeeding this child and any other child in the past. Variables about latch, frequency of feeds, duration of sessions, and use of supplements or pumping are all taken into consideration.
• Maternal Feedback: Enquiries into discomfort or pain during breastfeeding facilitate the establishment of feeding problems. Although pain is not a confirmation of tongue-tie, it is also an important point of diagnosis.
• Assessment of Infant Medical History: Other diseases/conditions, such as neurological disorders, congenital heart problems, or obstruction of the airway, can interfere with feeding. Other causes need to be excluded before concluding that it is tongue-tie that is causing the feeding issues.
• Physical Check-Up: A paediatrician will do a thorough oral examination and check the tongue, frenulum, and the structure of the mouth in general. They seek signs on the baby’s tongue or the areas around the mouth, such as restrictions or abnormalities.
• Direct Breastfeeding Observation: A lactation consultant watches a feeding session to assess:

• The baby’s latch technique
• The breastfeeding position
• The effectiveness of milk transfer

How to Treat Ankyloglossia?

Ankyloglossia treatment is controversial among medical professionals. Some are advocating the use of intervention as early as possible, and in many cases, before the baby leaves the hospital. The other group supports a more conservative approach and examines whether the condition would improve over time.

In other cases, the lingual frenulum can stretch or slacken naturally, and this enhances tongue freedom. There may be no treatment when the symptoms are mild or not present. Breastfeeding techniques can be helped by lactation consultants. In older kids or adults, speech therapy can help eliminate the problem of articulation.

Surgical Interventions for Ankyloglossia

1. Frenotomy (Simple Release Procedure)

• Technique: A minor surgical excision of the lingual frenulum by using aseptic, sharply pointed scissors or a cautery.
• Location: It is done in a doctor’s office or hospital and can be done without anaesthesia.
• Pain and Recovery: The range of pain is low, since there is less innervation; the babies are allowed to breastfeed after the procedure.
• Side effects: Uncommon and consist of:

• A little bleeding (normally only a drop or two)
• Infection
• Damage to the tongue or salivary gland.
• Reattachment or scarring of the frenulum

2. Frenuloplasty (Advanced Surgical Correction)

• Indications: Applied in cases where the frenulum is excessively thick or in the event where additional structural repair is necessary.
• Procedure: It is performed under general anaesthesia using surgical equipment; it may include the sewing of the place after release.
• Healing: Gradual healing is achieved with absorbable stitches.
• Post-op Care: Doctors may prescribe exercises like tongue mobility to enhance functioning and decrease the possibility of scarring.
• Possible Complications: Similar to frenotomy, but may also include:

• Greater scarring due to deeper dissection
• Reaction to anaesthesia
• Damage to nearby structures (rare).

FAQs About Ankyloglossia

1. Can ankyloglossia be prevented?

Ankyloglossia is an inborn condition, which, in other words, means that it cannot be avoided. It can be genetic; thus, there is no known measure to prevent its occurrence during pregnancy and foetal development.

2. Does ankyloglossia cause insomnia?

Insomnia is not associated with ankyloglossia itself. Nevertheless, in babies, it can cause frequent feedings during the night, as the infant may not latch well, which can disrupt its sleep patterns, along with the mother’s. It is seldom associated with sleep disturbances in adults.

3. Can adults have ankyloglossia?

Yes, adults can have undiagnosed or untreated ankyloglossia. While some remain asymptomatic, others may experience difficulties with speech, oral hygiene, or kissing. In some cases, surgical correction like frenuloplasty is considered for functional or aesthetic reasons.

4. Is ankyloglossia normal?

Ankyloglossia occurs frequently, yet it would not be described as normal when it poses problems with function, such as the inability to breastfeed, speak, or eat. Most of the cases are mild and do not need any treatment, but some may need clinical review depending on the severity of the condition.

5. How to treat ankyloglossia?

Treatment depends on severity. Mild cases often require no intervention. In symptomatic cases, options include breastfeeding support, speech therapy, or minor surgical procedures like frenotomy or frenuloplasty to release the lingual frenulum and improve tongue mobility.

Conclusion

Recognising and managing conditions like ankyloglossia early is essential to prevent complications in feeding, speech, and oral development. Although some cases resolve on their own, persistent or symptomatic tongue-tie requires timely clinical evaluation and, when necessary, appropriate intervention. For NEET PG aspirants, a clear understanding of the clinical presentation, diagnostic approach, and treatment options for ankyloglossia is vital for both academic success and future clinical practice.

To enhance your preparation, DocTutorials provides expertly curated video lectures, concise revision tools, and focused notes on high-yield ENT and paediatrics topics, including ankyloglossia. Join DocTutorials NEET PG course today to boost your readiness and take a confident step toward your medical career!