Sometimes, babies cannot completely push their tongues out, that is because, the tip of their tongue cannot go beyond the gum line, even if they force their tongues out, there is a paddy on the tip of the tongue, this is also called tongue frenulum. Although it is accepted that the average is 4%, the rates still can change between 1% and 11%. So it’s not uncommon.
Is it a condition that needs to be treated?
Its clinical importance, the need for treatment, and when and how it will be treated still remain uncertain in the medical world. Let me try to explain our experience to you.
If the tip of the tongue is not free, it may cause problems such as failure to grasp and suck the breast in infancy, difficulty in swallowing, impaired tooth development, and speech impairment. It is clear that an intervention must be made in these situations. We think that the timing of the intervention should be according to the problem.
Let me explain a little more. If the newborn baby has a tongue tie and the baby cannot suck because of this, if the baby cannot gain weight, if damages the mother’s nipple and leaves a bruise, it can be easily cut within the first 15 days under polyclinic conditions. In a study we conducted, we wrote and published the technique that we easily applied in the first 14 days to 41 babies. All babies had feeding difficulties. We saw the babies again after 1 week, 4 weeks and 12 weeks. In our follow-up, we did not observe any infection or similar problems, except for slight bleeding in the form of leakage. None of them needed a second procedure, and weight gain of all of them reached the expected level, and complaints of 9 out of 11 mothers with nipple pain regressed. Again, you can read our article clicking here. Although it is not necessary for very young babies, postoperative tongue-tie massages can be performed to prevent re-sticking. We don’t do it on routine.
In the past, the tongue tie was cut routinely until the 1950s. Even midwives cut it with their nails when they realised it as soon as they were born. Of course, who knew what were the consequences… We now only cut it off if the problems that I just mentioned has occurred.
What about tounge ties that don’t pose a problem?
There is no need for early intervention. There are publications that say it can recover up to six months. There are also those who say that the tongue ties can regress in babies by simply massaging them without surgery, but I have already stated that if the baby does not need immediate intervention, it can pass spontaneously up to 6 months.
If not, our approach is again clinical. If it causes problems, if the child is unhappy because the baby cannot stick its tongue out, if there is psychosocial discomfort, oral hygiene problems, dental problems, we intervene. Of course, unlike infancy, we perform the intervention in older children in the operating room under general anaesthesia. Since the tongue tie may become thicker and become more common like a fan, it may be necessary to use cautery and stitches.
Sometimes, while performing another surgery, we can cut it, even if it does not create a clinical problem at the request of the families. For example, due to simple surgeries such as circumcision, undescended testicle and hernia, we can cut the tongue tie while the child is already sleeping in the operating room.
Let me add a short anecdote here: a doctor friend had asked me to cut the tongue tie while circumcising his 9-year-old child. When they came to the check-up later, the boy said to me “how enjoyable was it to eat ice cream”. In other words, it is unnecessary to take it to the operating room and give anaesthesia just for this, but it may be meaningful to cut it quickly while performing another surgery.

As a result, the tongue tie should be remembered and cut in the first 15 days in babies who cannot breastfeed despite having a desire to feed, who can only be fed with a bottle, whose mother’s nipple is painful and whose tongue cannot be pulled out, and the tip of the tongue takes the shape of a heart while removing it. Older children should be treated in the operating room under general anaesthesia. If it does not cause any problems, actions should be taken in line with the approval and request of the child and parents while performing other outpatient surgeries.

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