While reviewing information, the author occasionally found mixed information on the internet about short tongue ties. It is impossible to provide accurate information for the parents of babies. In particular, there are academic errors and self-contradictory assertions on a well-known website. Some parents are still confused and confused after consulting the information. Some of the author’s patients’ families have also raised this issue. As an oral and maxillofacial surgeon, it is the author’s responsibility and obligation to put the issue of short lingual tethering into perspective. The lingual ligament, also called the lingual band in some areas, is a thin strip of tissue between the tongue and the floor of the mouth when we open the mouth and lift the tongue. It is similar to the fleshy membrane between the two toes of a duck’s paw. In a normal newborn, the tongue tether extends to or near the tip of the tongue. During the development of the tongue, the ligament gradually recedes toward the root of the tongue. However, in cases of abnormal development, the lingual tether does not retract or does not retract sufficiently, which is why the lingual tether is short. The tip of the tongue has a “W”-shaped tip due to the traction of the tongue. When the mouth is opened, the tip of the tongue cannot be tilted up and licked to the upper part of the mouth, and the tongue cannot be rolled up. In order to overcome the traction of the lingual ligament, the child will incorrectly extend the tongue between the upper and lower teeth, or compensate by raising the dorsum of the tongue, thus forming an abnormal articulation, and cannot correctly pronounce the linguopalatal and velar consonants. The main reason for the short lingual ligature is that the short lingual palatal ligature causes the inaccuracy of the lingual and lingual consonants. The word “pants” is said as “rabbit”. However, not all children with short tongue ligament will have slurred pronunciation, which means that not all children with short tongue ligament will need surgical treatment. Without further ado, let’s talk about the concerns of the child’s family: 1. Nowadays, the timing of surgery is not consistent among the academic community and hospitals, ranging from newborn to five or six years old. And each has its own reasoning. Even different doctors in the same hospital give different answers. This has caused confusion among families. In the end, who should listen to that. First of all, purely from the perspective of the tongue tie, we recommend that the surgery be done between six months and one year of age. This will solve the anatomical problem before the child can speak. But from the child’s physical point of view, it must be done under general anesthesia at this age, and the family will bear the risk of surgery. Also, the surgical area is smaller, making it more difficult to perform the surgery, and there is a risk that it will not be done adequately and will need to be done again later. In this regard, the older the child is, the better. In particular, after the age of five, you can basically do it on an outpatient basis under local anesthesia. But these two problems occur in the same child. The point is, is there an exact time? No, there is not. But the author recommends that the surgery be done between the ages of one and three. The timing of surgery depends on the severity of each child, if the child is weak at feeding and the tongue cannot wrap around the pacifier, which affects feeding. Or if the child has recurrent ulcers in the tongue tie during teething. In these two cases, surgery is recommended in a timely manner. If the tongue tie is still attached to the tip of the tongue at eight months to one year of age and shows no signs of retraction. Surgery is recommended before one year of age. If the tongue tie, although a little short, is not attached to the tip of the tongue and the tongue can be partially extended out of the mouth. Then it can be observed. If there is no improvement by the age of three and the tongue tip remains forked or “w” shaped when extended with slurred pronunciation, surgery is recommended. Surgery is recommended. After the surgery, additional phonological training should be done. If the problem is detected after the age of three, it is recommended to do it as soon as possible. If the tongue tie is short but does not affect the pronunciation, you may choose not to have the surgery. The timing of surgery cannot be determined by a few articles alone for families without medical experience. Ultimately, the decision will be made by an experienced surgeon at the hospital. At the same time, it is recommended that each newborn baby can go to the dental hospital for a checkup before the age of one. 2, general anesthesia do or local anesthesia do? This may be the most concerned about the family, this surgery before the age of four is generally recommended to do general anesthesia, local anesthesia children basically do not cooperate. Can not be done, facing the possibility of secondary surgery. And the psychological and parental tolerance of the child is also a challenge. Nowadays, general anesthetics are very safe and do not harm the child’s brain. There is no possibility that you will become stupid after doing it. Of course, the cost of general anesthesia will be slightly more. Outpatient surgery is generally about four hundred, and hospitalization is almost two to three thousand. 3, surgical trauma. This surgery, whether general anesthesia or local anesthesia, is a minor surgery. Generally ten minutes can be done. Longitudinal cut with scissors, horizontal alignment sewn on it. 4.After the surgery, is it normal to pronounce? This depends on the age of the surgery. Surgery done before one year old usually does not affect the child’s learning of pronunciation. Generally speaking, there is no need for speech training. For children who have the surgery after 2 or 3 years old, there is not much improvement after the surgery. It is necessary to do further speech training. It is necessary to correct the bad pronunciation habits. I will tell you the specific voice training method separately. 5.What are the precautions after surgery? Generally, you can eat in four hours after the surgery under general anesthesia, and you can eat and drink in two hours after the surgery under local anesthesia. You cannot brush your child’s teeth and rinse your mouth for 24 hours and restrict your child’s tongue movement.
Within 24 hours, you can eat warm and cool liquid or semi-liquid food, avoid spicy stimulation and too hot, and avoid strenuous exercise. It is normal to have slight blood in the mouth for 1 to 2 days, but if there is a lot of bleeding, please seek medical attention promptly. To prevent infection you can take oral antibiotics such as Schiclau for 2-3 days. The sutures can usually fall off confidently without removing the stitches. If you have conditions, you can directly choose absorbable thread. After seven days, you can basically resume normal diet. 6.Is all slurred pronunciation caused by tongue tie? Some parents attribute their children’s inability to pronounce to the short tongue tie. The inability to pronounce and spit out words is certainly related to the short tongue tie, but it is not the only reason for inability to pronounce. The short tongue tie usually only affects the child’s inaccurate pronunciation of individual words, but does not play a major role in the overall pronunciation. It does not play a major role in the overall pronunciation of the word, which is basically a curly tongue sound. There are two main reasons for inaccurate pronunciation: one is congenital physiological defects, such as cleft lip and palate, missing teeth or malformation, and short tongue tie; the other is due to acquired diseases, such as neurological disorders that cause uncoordinated vocal movements when children are young. For example, children with neurological disorders that cause uncoordinated vocal movements, hearing impairment that prevents them from hearing sounds and imitating them correctly, and brain development disorders can all cause mispronunciation. In addition, the vocabulary of children before 3 years old is gradually increasing and they want to use language to express their thinking, so they often have mispronunciation, especially some complex sounds. This is because they have just learned to speak, and the language center of the brain and vocal organs are not mature, or they are influenced by the language environment in the process of learning to speak. For example, the “F” and “H” in individual provinces are not clear. Therefore, there are multiple reasons for unclear pronunciation, not necessarily caused by a short tongue tie. However, it is recommended to go to the stomatology department for examination first, and then go to other departments for further examination after excluding stomatological problems.