Recently, many parents bring their children to the hospital to ask for “tongue cutting”. What’s the deal with “tongue-trimming”? Is it really necessary? Tongue tendon is the common name for tongue tie. Tongue tie is a thin strip of tissue between the tongue and the floor of the mouth when the child opens his or her mouth and lifts up the tongue, it is the mucous membrane of the sublingual region formed in the midline connecting the sublingual area with the alveolar mucous membrane of a tie. Normally in the newborn, the tongue tie extends to or near the tip of the tongue. During the development of the tongue, the tie will gradually recede towards the base of the tongue, so infants and young children are not able to extend and turn their tongues freely from birth, but rather start with a short tongue that is just able to suck, and then due to the need for milk, speech and pronunciation, etc., after a series of years of related long activities and exercises, which makes the tip of the tongue gradually move away from the tie, and thus move towards normalcy. Short tongue tie is a kind of congenital developmental abnormality, which is mainly manifested by the short tongue tie at the center of the tongue, which restricts the normal activities of the tongue, and therefore the tongue can not be stretched to the outside of the mouth, or upward can not touch the upper lip; when the tongue is stretched out in front of the tongue, due to the short tie pulling on the tongue, so that there is a small depression at the back of the tongue, and the tip of the tongue is in the form of a “V” shape or a “W” shape. In severe cases, it affects sucking, clarity of speech and learning of language. This condition is commonly known as “big tongue”. Let’s first look at the diagnosis and evaluation of a short tongue tie. If the tongue tie is attached to the tip of the tongue and the other end is attached to the anterior side of the floor of the mouth, which restricts the movement of the tongue, preventing it from sticking out of the mouth in an outward direction, and preventing it from licking the palate in an upward direction, then it can be recognized as a tongue tie that is too short. Generally speaking, it is best to observe this condition after the age of 2 years, when the tip of the tongue begins to move away from the tongue tie. If the tongue tie is too short and affects anterior tongue extension, or even prevents clear speech, then a diagnosis can be made and further treatment can be sought. The dangers of a short tongue tie include ulcers during suckling in infancy when the tongue tie is too short and is often rubbed by the two lower incisors. A short tongue tie also restricts the movement of the tongue in the oral cavity, affecting spitting and pronunciation, especially on the rolled back, palatal and lingual sounds, such as /l/, /r/ and /ch/ in the Hanyu Pinyin alphabet, which are difficult to pronounce. Due to the restriction of tongue movement, chewing is also affected. Let’s take a look at the correct treatment of short tongue tie. Short tongue tie can be treated with surgery if necessary. However, there are some misconceptions about short tongue tie in daily life. The following are some common misconceptions: 1, short tongue tie is not normal for infants Some parents find that the tongue tie of infants is relatively short, the tip of the tongue can not be upward when the mouth is open, the tongue’s activities are not flexible, it is thought that it is not normal. In fact, the infant’s tongue tie is in the development stage. In the neonatal period, the tongue tie is extended to the tip of the tongue or close to the tip of the tongue. During the development of the tongue, the tongue tie gradually retreats to the root of the tongue, and the tip of the tongue gradually moves away from the tongue tie after 2 years of age in normal children. Therefore, in infancy, the tongue ligament becomes tense, and the tongue ligament may be “too short”, which is a temporary physiological phenomenon and should not be considered abnormal. With the growth of age and the eruption of milk teeth, the attachment of the tongue tie will gradually move to the bottom of the mouth, gradually become thin and loose, tongue mobility will become more flexible, tongue tie is not short. 2, the child’s inability to pronounce is due to the short tongue tie Some parents attribute the child’s inability to pronounce to the short tongue tie, as long as the child has a little bit of speech performance, the child will take the child to the hospital to request to cut the tongue tie. The shortness of the tongue tie is certainly related to the inability to pronounce words, but it is not the only cause of inability to pronounce words. A short tongue tie usually only affects the child’s inaccurate pronunciation of certain words, but does not play a major role in the overall pronunciation. There are two main causes of mispronunciation: first, congenital physical defects, such as congenital cleft lip and palate, missing or malformed teeth, and short tongue tie; and second, acquired illnesses, such as neurological disorders that result in uncoordinated movement of the vocal organs when the child is young, impaired hearing that results in inability to hear the sounds and mimic them correctly, and developmental disorders of the brain that can lead to mispronunciation. In addition, before the age of 3, children’s vocabulary is gradually increasing, they want to use language to express their own thinking, so there are often mispronunciation phenomenon, especially some of the more complex sounds. This is because they have just learned to speak soon, and the language center of the brain and the vocal organs are still immature, or in the process of learning to speak caused by the influence of the language environment. 3, short tongue tie surgery the sooner the better Some parents are worried that the short tongue tie will affect the child’s pronunciation, speak, insist on letting the doctor early surgery, that early surgery does not need anesthesia, do not need stitches, less bleeding. Unbeknownst to them, early surgery (at 2 to 6 months of age) can lead to scarring of the surgical wound, which makes it necessary for some children to undergo a second surgery. Moreover, most of the children can’t cooperate well with the doctor during the operation, and the slightest carelessness will easily cause accidental injury, and it is also easy to combine with infection. In addition, early surgery can have a greater psychological impact on the child than the physical damage. Currently, professionals recommend surgery after the age of 4 or around the age of 5. This is because the tongue tie gradually moves backward as the child gets older. Even if the tongue tie is too short, it can be improved with training and most children do not experience any dysfunction. A child’s articulation is related to factors such as auditory function, language environment, intellectual development, and degree of articulation. These factors are not perfected until the age of 4 years, so children before the age of 4 or younger can be observed and followed up. If a child is found to have tongue tie problems at an early stage, it is not advisable to blindly “cut the tongue tie” too early. It is better to go through professional judgment or further observation, and at the same time carry out the appropriate tongue movement training or speech therapy, in fact, most children do not need to be cut.