400 Section IX ■ Miscellaneous Procedures

discomfort, improved latch, stronger suckling, and

absence of the clicking sounds frequently produced by

the tongue-tied infant while breast-feeding

(6,7,18,19,21–28).

If no improvement is noted, it is important to work

with mother and baby in suck training and continue

frequent re-evaluation.

12. Antibiotic therapy is not required.

13. Postoperatively, a white fibrin clot may form.

Reassure parents that this is not a sign of infection.

14. Arrange follow-up in 1 to 2 weeks to check healing of

the incision.

J. Complications (2,6,13,18,19,24,26)

1. Extremely rare when performed by a practitioner familiar and comfortable with the procedure

a. Excessive bleeding virtually never occurs unless

deep lingual arteries and/or veins are severed.

b. Infection: Extremely rare

c. Damage to tongue: Extremely rare

d. Damage to submandibular ducts: Extremely rare

e. Recurrent ankyloglossia due to excessive scarring

(1) Generally less severe than original presentation

(2) Often amenable to revision surgery

f. Glossoptosis (tongue swallowing) due to excessive

tongue mobility

Theoretical concern—has never been reported

in modern literature.

Acknowledgement

Photographs and assistance with procedural information on

posterior tongue tie courtesy of Evelyn Jain, BA, BSc, MD,

FCFP, Clinical Assistant Professor, Department of Family

Medicine, University of Calgary, Calgary, Alberta, Canada.

Fig. 57.8. Completed frenotomy of posterior tongue tie with

open diamond evident. (Photograph courtesy of Evelyn Jain BA,

BSc, MD, FCFP.)

References

1. Hall DMB, Renfrew MJ. Tongue tie. Arch Dis Child. 2005;

90:1211.

2. Lalakea ML, Messner AH. Ankyloglossia: does it matter?. Pediatr

Clin North Am. 2003;50:381.

3. Kupietzky A, Botzer E. Ankyloglossia in the infant and young

child: clinical suggestions for diagnosis and management. Pediatr

Dent. 2005;27:40.

4. Hong P, Lago D, Seargeant J, et al. Defining ankyloglossia: A case

series of anterior and posterior tongue ties. Int J Pediatr

Otorhinolaryngol. 2010;74:1003.

5. Chu MW, Bloom DC. Posterior Ankyloglossia: a case report. Int

J Pediatr Otorhinolaryngol. 2009;73:881.

6. Hansen R, MacKinlay GA, Mansen WG. Ankyloglossia intervention in outpatients is safe: our experience [letter]. Arch Dis Child.

2006;91:541.

7. Naimer SA, Biton A, Vardy D, et al. Office treatment of congenital ankyloglossia. Med Sci Monit. 2003;9:CR432.

8. Wallace H, Clarke S. Tongue tie division in infants with breastfeeding difficulties. Int J Pediatr Otorhinolaryngol. 2006;70:1257.

9. Kummer AW. Ankyloglossia: to clip or not to clip? That’s the

question. ASHA Leader. 2005;10:30.

10. Lalakea ML, Messner AH. Ankyloglossia: the adolescent and

adult perspective. Otolaryngol Head Neck Surg. 2003;128:746.

11. Lalakea ML, Messner AH. The effect of ankyloglossia on speech

in children. Otolaryngol Head Neck Surg. 2002;127:539.

12. Marchesan IQ. Lingual frenulum: classification and speech interference. Int J Orofacial Myol. 2004;30:31.

13. Messner AH, Lalakea ML. Ankyloglossia: incidence and associated

feeding difficulties. Arch Otolaryngol Head Neck Surg. 2000;126:36.

14. Hazelbaker AK. The assessment tool for lingual frenulum function. Master’s thesis. Pasadena, CA: Pacific Oaks College; 1993.

15. Kotlow AL. Ankyloglossia (tongue-tie): a diagnostic and treatment

quandary. Quintessence Int. 1999;30:259.

16. Williams WN, Waldron CM. Assessment of lingual function when

ankyloglossia (tongue tie) is suspected. J Am Dent Assoc. 1985;110:353.

17. Ruffoli R, Giambelluca MA, Scavuzzo MC, et al. Ankyloglossia: a

morphological investigation in children. Oral Dis. 2005;11:170.

18. Griffiths DM. Do tongue ties affect breastfeeding? J Hum Lact.

2004;20:409.

19. Wright JE. Tongue-tie. J Paediatr Child Health. 1995;31:276.

20. Horton CE, Crawford HH, Adamson JE, et al. Tongue-tie. Cleft

Palate J. 1969;6:8.

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