Tongue-tie (Ankyloglossia)

What is Tongue-tie?

Tongue-tie is an abnormality present from birth in which the membrane linking the tongue to the floor of the mouth (lingual frenulum) is too short. This prevents the tongue from protruding past the lower gums. Tongue-tie can occur to varying degrees, from minor shortening to complete fusion of the tongue to the floor of mouth. Sometimes patients with tongue-tie may have other abnormalities of the mouth such as a high arched palate or recessed chin. Tongue-tie is usually an isolated finding in otherwise normal infants. Up to 5% of all babies have some form of tongue-tie.

What are symptoms & types of tongue-tie?

Tongue-tie is usually diagnosed during a routine baby exam either in the hospital or the pediatrician’s office. The most common symptom of tongue-tie in infants is difficulty with breast-feeding due to problems latching on to the nipple. As the child grows older, speech difficulties may develop. Children with tongue-tie may have problems articulating of the sounds requiring elevation of the tongue, such as “l” and “th”. A short frenulum may inhibit normal swallowing by preventing the tongue from coming into contact with the roof of the mouth. This may eventually lead to a protruding lower jaw due to repeated efforts to thrust the tongue forward while swallowing. These repetitive efforts may also cause the lower incisor teeth to move forward. Certain social experiences, such as licking an ice cream cone or kissing, may be difficult.

How is tongue-tie diagnosed?

Tongue-tie is diagnosed by physical exam. Dr. Lieberman evaluates the patient’s ability to protrude the tongue beyond the lower dental ridge. During protrusion, the tip of the tongue may become grooved and heart-shaped as the short frenulum pulls against the midline.

How is tongue-tie treated?

Two schools of thought exist regarding treating infants and children with tongue-tie. The first is a “wait and see” approach. It is possible that compensatory behaviors may allow children to develop normal speech and swallowing over time without treatment, thus avoiding surgery.

Another approach is to perform a procedure known as a frenuloplasty at the time of diagnosis. Surgery may avoid speech problems that may develop and become more difficult to correct as the child grows older. Surgery may also avoid the other social and cosmetic effects of tongue-tie may persist, even with normal speech. Frenuloplasty is usually a simple procedure, lasting no more than a few minutes. In the newborn, this can be done in the office without sedation using local anesthetic. Older children will usually require a general anesthetic. Recovery is rapid, with resumption of breast -feeding or liquid diet immediately after surgery.

Salivary Glands

What are salivary glands?

As one might expect, the salivary glands are responsible for secreting saliva into the mouth to moisten the oral cavity and assist in breaking down food. Humans have three pairs of major salivary glands: the parotid glands, submandibular glands and sublingual glands. The parotid glands are located in front of the ear, overlying the angle of the jaw and extending into the upper neck. The submandibular glands are smaller and are located under the jaw. The sublingual glands are the smallest major salivary glands and are located in front of the submandibular glands and under the tongue. In addition to the major salivary glands, hundreds of minor salivary glands, each about the size of a grain of sand, line the membranes of the inside of the mouth.

What are salivary gland tumors?

Tumors can arise from the various cells in the salivary glands when the body’s normal regulating mechanisms do not function as they should. Salivary gland tumors can be either benign (non-cancerous) or malignant (cancerous). Tobacco use is a risk factor for the development of malignant salivary gland tumors. As a general rule, the likelihood of a salivary gland tumor being malignant is inversely proportional to the size of the gland. Tumors of the parotid glands, the largest salivary glands, have only a 20% likelihood of malignancy, whereas tumors of the minor salivary glands have an 80% likelihood of being malignant. The most common type of benign salivary gland tumor is a benign mixed tumor, or pleomorphic adenoma.

How are salivary gland tumors diagnosed?

Most salivary gland tumors present as a lump in the face or neck. There are rarely any other symptoms. Pain is uncommon. Muscle weakness of the face on the side of the tumor is a worrisome finding. Once a salivary gland tumor has been detected by Dr. Lieberman, further diagnostic testing (e.g. CT or MRI scan) may be recommended. A fine needle aspiration (FNA) biopsy of the tumor may also be done to determine the type of tumor.

How are salivary gland tumors treated?

Surgical excision is the treatment of choice for most salivary gland tumors. Even tumors felt to be benign on needle biopsy should generally be removed, since the tumor will typically continue to grow, leading to increasing cosmetic and functional problems. Surgery to remove the parotid gland is called a parotidectomy. Surgeries to remove the submandibular gland or sublingual gland are referred to as excision of submandibular gland, and excision of sublingual gland, respectively. If the tumor is malignant, Dr. Lieberman may recommend additional treatment, such as radiation therapy.

Facial Paralysis

Facial paralysis involves a loss of voluntary muscle movement within the face. The facial nerve stretches down each side of the face and controls the ability to show expression, smile, cry, wink, etc. A facial nerve that does not function properly can be a socially and psychologically devastating physical defect.

What causes facial paralysis?

There are numerous causes of facial nerve disorder. Some examples include:

  • Trauma such as birth trauma, skull base fractures, middle ear injuries, facial injuries
  • Nervous system disease, e.g. stroke
  • Infection of the ear or face or herpes zoster of the facial nerve (Ramsey Hunt Syndrome)
  • Tumors such as acoustic neuroma, parotid tumors, schwannoma
  • Toxins due to alcoholism or carbon monoxide poisoning
  • Bell’s Palsy

How is facial paralysis treated?

Although many cases resolve spontaneously, there are times when treatment is extensive. Depending on the cause of the paralysis, the treatment may include medication, physical therapy or surgery to relieve pressure on the facial nerve.