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| LETTER TO EDITOR |
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| Year : 2018 | Volume
: 3
| Issue : 1 | Page : 61-62 |
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Severe ankyloglossia with failure to thrive
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
| Date of Web Publication | 19-Jun-2018 |
Correspondence Address:
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University Kano, Kano
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/bjhs.bjhs_22_17
How to cite this article:
Aliyu I. Severe ankyloglossia with failure to thrive. BLDE Univ J Health Sci 2018;3:61-2 |
Dear Sir,
Ankyloglossia is also called tongue tie; this is a congenital abnormality resulting from a congenitally short and or thickened lingual frenulum which restricts the mobility of the tongue.[1] This defect may occur as an isolated anomaly or associated with other congenital malformations. The effect of tongue tie depends on the severity of restricted tongue mobility; resulting in breastfeeding and swallowing difficulties, maternal nipple cracks and damages, speech deficits.[1] Diagnosing ankyloglossia has posed some challenges in the past with several criteria been published.[1] This communication highlights the case of a 12-month-old girl who presented with poor growth since birth. She was delivered at term, and the pregnancy and delivery were not adversely eventful, she was delivered at home and cried actively at birth; though the birth weight was not taken, but mother reported she was of normal size at birth. However, the mother noticed she was not growing when compared to her peers. There was no history of recurrent vomiting or diarrhea; no cough or difficulty in breathing she was not exclusively breastfed but she suckled poorly. She was unable to protrude the tongue. She had been taken to primary health-care centers for these complaints. She was pale, no peripheral edma, her anthropometry showed a weight of 4.3 km, occipitofrontal circumference of 40 cm, length of 53 cm and a mid-upper arm circumference of 11 cm; these were all deranged. She was yet to sit or develop neck control; the oral examination revealed absent dentition, the tip of the tongue could not move beyond the gum margin and the frenulum was barely visible; all other systems had no remarkable findings. Her packed cell volume was 18%, with genotype of AA and the blood film revealed microcytic hypochromic anemia. Nasogastric tube was passed and was fed with high energy diet (F100) and was also transfused. The weight progressively appreciated rising up to 5.4 km by the 2nd week.
The effect of ankyloglossia on growth and development of breastfed babies has been an issue of controversy. While most pediatricians, otolaryngologists [2] and maxillofacial unit (MFU) surgeons believe it has no influence on growth, lactation specialist hold contrary views; we also experienced this divergent views in the index case; both ENT and MFU surgeons in our center attributed the growth failure more to adenoid hypertrophy; however, we believed it was due to failure of adequate breastfeeding which accounted for the growth failure;[3],[4] the history from the index case also established the challenges and difficulty at breastfeeding; and this was clearly proven when nasogastric tube was passed resulting in appreciable weight gain within a short time. Smith et al.[5] in their ultrasound study of the tongue showed that effective mobility of the tongue is vital in breastfeeding. Therefore, the impact of ankyloglossia on growth and development should not be undermined.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005;41:246-50.  [ PUBMED] |
| 2. | Tait P. Nipple pain in breastfeeding women: Causes, treatment, and prevention strategies. J Midwifery Womens Health 2000;45:212-5. [ PUBMED] |
| 3. | Marmet C, Shell E, Marmet R. Neonatal frenotomy may be necessary to correct breastfeeding problems. J Hum Lact 1990;6:117-21. [ PUBMED] |
| 4. | Messner AH, Lalakea ML. Ankyloglossia: Controversies in management. Int J Pediatr Otorhinolaryngol 2000;54:123-31. [ PUBMED] |
| 5. | Smith WL, Erenberg A, Nowak A, Franken EA Jr. Physiology of sucking in the normal term infant using real-time US. Radiology 1985;156:379-81. [ PUBMED] |
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