All issues > Volume 15(10); 1972

Case Report

J Korean Pediatr Soc. 1972;15(10):959-964. Published online October 31, 1972.

Tongue-Tie

Young Chirl Moon¹, Shin Ho Park¹, Young Soon Yun¹

¹Department of Pediatrics, Seoul Adventist Hospital Seozd, Korea

Abstract

In the newborn infant, tongue-tie presents occasionally a minor difficulty in nursing, either in taking the breast or bottle. In regard to the breast, especially if the nipple is short or retracted, there may- be some difficulty, but this can be corrected by gentle massage of the mother’s nipple, not after she has been delivered but in the last month of gestation. Historically, some writers favor cutting the frenum of the tongue-tied infant for nursing. Others oppose it, because there is a possibility of a subsequent infection at the base of the tongue, with the formation of a large ulcer and a spreading stomatitis which makes it difficult to feed the baby. This
results
in severe dehydration and weight loss. When this ulcer at the base of the tongue heals, it often leaves a large amount of scar tissue which makes for marked immobilization of the tongue. Several month ago, the auther experienced that his first born daughter normally had troubled with ‘ breast feeding with no apparent reason for it until 3 days age. After thoroughly checking the baby’s oral cavity two causes were found to possibly be the causes. The one cause was mild degree of tongue- tie of the infant, and the other cause was mother’s nipple was too short Therefore the author clipped the upper 1/3 portion of mild degree of tongue-tie once using sterilized pincet and scissors, after which the infant could nurse the breast feeding dramatically. No bleeding, infection, other complications or scar-formation on the site of cut developed. She has been observed closely several months with no other problems noted. Reliable data about incidence of tongue-tie have not been reported. A famous doctor deplores the lack of good statistics. Therefore the authors studied the 560 newborn infants which were born at Seoul Adventist Hospital, Seoul, Korea, during 4 months period from July 1971 to November 1971. The following observations were made: 1. In examining the baby’s oral cavity, the authors found that a great many various and congenital anomalies. However'they didn’t appear to cause clinical symptoms, therefore they may be considered as normal. 2. 4 infants were found to have an enlarged sublingual fold giving the appearance of a small tongue beneath the usual tongue. This representative 0.1% of the infants. 3. Mild degree of tongue-tie was found in 45 infants or 8% of the total. 4. Snort and thick lingual frenum was present in 1. 8% of the total infants. It was found in 10 infants of the 560. 5. There were 30 male and 25 female, rate of sex: 1. 2 : 1. 6. Of six infants who had moderate difficulty in nursing, in taking the breast or beetle, all had mild degree of tongue-tie, and had no other causes of difficulty in nursing, which was present in 1% of the total, and 9% of the 55 infants who had tongue-tie. 7. The following treatment was done for those 6 infants: a. The frenum 1/3 to 1/4 was cut transversally once using sterilized pincet and scissors. After cut all infants could nurse well dramatically, and a few days later, all were discharged with good condition. b. Even though no local anesthetic agent was used while cutting the tongue-tie, the infants didn’t seem to have any pain. No infections were developed even though no antibiotics were used. Hemostatic agents were not used for all. Some infants had minimal bleeding but soon clotted and some didn’t bleed at all. c. On discharge from the hospital, the infants were evaluated for large scar on the cut area was very small, because there was no infection and ulceration after the cut. There was not much differences as compared with the mucous membrane band which was present before the cut. d. The range of motion of tongue was more broad as compared with before cut. 8. Review of tongue-tie discussed. Z-plasty is indicated for the treatment of short and thick frenum and we report that 6 infants who had moderate difficulty in nursing due to mild degree of tongue-tie were improved without other complications. A careful, shallow cut was made with sterilized scissors which were used only one time.

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