Short Frenulum

אתמול היינו עם אופיר, בת חדשיים וחצי, במיון ילדים עקב חום ושיעול. בלי קשר למצבה הנוכחי, הרופא שבדק אותה אמר שיש לה לשון קשורה- Short Frenulum או Tie Toungue, ואמר שיש לנתח אותה עד גיל שנה על מנת למנוע בעיות אפשריות בדיבור. רצינו לשאול- מהי לשון קשורה? מה גורם לזה? האם זו תופעה תורשתית? מה ההשלכות? האם חייבים לנתח ואם כן באיזה גיל? האם הניתוח הוא בהרדמה מלאה? והאם תוכלו להפנות אותנו לחומר בעברית בנושא? תודה!!

לשון קשורה איננה תורשתית בד"כ, לא חייבים לנתח. לא מצאתי חומר בעברית אך רצ"ב חומר באנגלית TONGUE-TIE (short frenulum) My mother thinks that our baby has tongue-tie. Could this interfere with nursing? Tongue-tie means that the membrane (the frenulum) that attaches the tongue to the floor of the mouth is shorter than usual. Some babies with tongue-tie breastfeed perfectly well; others have difficulty. If the tongue-tie is interfering with breastfeeding, it's possible to clip the frenulum to release the tongue. Signs that the tongue is tight enough to warrant clipping are: · Latch-on is painful to mother · Baby is not getting enough milk · The tip of the tongue doesn't protrude past the lower gum · The tongue curls under when baby cries, opens her mouth wide, or tries to suck (it should curl upward and form a trough) After clipping, mothers almost immediately notice that latch-on is more comfortable and baby is able to nurse more effectively. Clipping a frenulum is a quick and painless procedure that can be done in your doctor's office. In the early weeks, the frenulum is so thin that it's easy to clip and usually yields only a few drops of blood, or none at all. While baby's mouth is open (either normally open or when crying), the doctor holds the tip of the tongue with a piece of gauze (sometimes if the mouth is open wide enough, holding the tongue is not necessary) and uses scissors to clip the frenulum back to where it joins the base of the tongue. If your doctor or lactation consultant feels that you are having breastfeeding problems caused by tongue-tie, get the baby's tongue clipped. Some doctors may be reluctant to do this procedure, because most tight tongues loosen with time. However, these physicians are probably not aware of how a baby must use his tongue to get milk out of the breast. Enlist the help of your lactation consultant to persuade your baby's doctor to clip the short frenulum. The LC may also be able to refer you to a physician who is willing to do this procedure, if your doctor is not. Tongue- Tie (Ankyloglossia) Tongue-tie is a condition in which the lingual frenulum is either too short or anteriorly placed limiting the mobility of the tongue. Early in fetal development, the tongue is attached to the floor of the mouth. With cell death and atrophy, the only attachment is the frenulum. Tongue-tie results when the frenulum is short and this may limit the movement of the tongue. When there is an attempt to stick the tongue out, there may be a V shaped notch at the tip. The incidence is 0.5/1000 Physical exam will easily demonstrate the short or andteriorly placed lingual frenulum. Years ago it was routine to clip the frenulum at the time of delivery. Midwives had a long sharp nail to cut the frenulum and obstetricians would inspect the mouth and cut the frenulum immedialtely after the delivery. It was felt that tongue-tie was associated with speech abnormalities especially lisping and inability to pronounce certain sounds. Tongue-tie actually represents partial ankyloglossia and fusion represents complete ankyloglossia. There is no evidence in the literature that partial tongue-tie causes speech defects, difficulty breastfeeding, or dental problems. The tip of the tongue normally grows until 4 years of age, and initial restrictions of movement may improve as the child gets older. Therefore, frenulectomy should not be performed before 4 years of age. Management 1. Physician education 2. Parental education and reassurance 3. Complete fusion requires surgery The frenulum is a thin band of tissue beneath the tongue. In most people, this band of tissue is barely perceptible and does not limit tongue motion. In some people, the frenulum is short and dense, limiting tongue motion. This condition is known as "tongue-tie," or ankyloglossia, and it is usually noticed in infancy. Tongue-tie, if extreme, can cause problems with feeding and speech development. Your son clearly is not having problems feeding, but it is too early to assess his speech development. Not all tongue-ties need to be clipped. Once your son begins talking, it may be obvious that this surgical procedure is necessary; if there is any doubt, you should have a speech therapist examine your son and offer her/his opinion. Is there any way to tell now if the tongue-tie will cause problems? Indicators of a problematic tongue tie are: notching of the tongue tip; inability to protrude the tongue tip beyond the upper gums; inability to touch the tongue tip to the roof of the mouth, immediately behind the incisors; difficulty moving the tongue from side to side. If some or all of these problems are present, you can anticipate speech articulation problems in the future. Some practitioners clip tongue-ties with the infant awake, with or without local anesthesia. The rationale behind this is avoidance of the risks of general anesthesia. I personally think this is barbaric and unsafe, and I only do these procedures under general anesthesia. This allows me to control bleeding and place sutures with great ease and with minimal trauma to the infant. Aside from infants and toddlers, there is one other group of tongue-tied patients who demand treatment, even though they have no problems eating or speaking. Tongue-tied teenagers typically become very unhappy when they realize that their condition interferes with their love life. Unlike infants and toddlers, clipping is easily accomplished in teenagers under local anesthesia.