Implications of Tongue and Lingual Frenulum Anatomy for Tongue-Tie Evaluation and Management

Abstract

The tongue's function is indispensable for survival. It is involved in breathing, swallowing, sucking, eating, speech and oral and dental health by performing diverse movements and assuming various shapes in three dimensions [1].

Unlike most muscles, the tongue is a muscular hydrostat, an almost free-floating muscle, not attached to bone on both ends, moving similarly to an elephant's trunk or octopus' arms. This large muscle group varies its shape while keeping the total volume constant [2], forming the palate and mandible, enabling a physiological tongue rest position. The range of motion can be affected by a frenulum linguae breve, also called tongue-tie.

The lingual frenulum is a central fold of the floor of the mouth fascia and the overlying mucosa created by tongue elevation [3]. The floor of the mouth and the tongue blade are wrapped by fascia and mucosa, with a connection in the midline. The mouth fascia is also continuous with other body fascia. When the tongue is not elevated, no frenulum is visible or palpable. When the tongue is raised, a central fold is created (Figure 1a,b) [3].

In the past 16 years, the authors have collected videos and photos (MGG) and performed scissors frenotomies, creating a diamond shape (DK) [4]. A more detailed manuscript on the tongue's and lingual frenulum's anatomy and implications is in preparation.

To summarise, the tongue muscles (strength) and their functions (coordination) can and have to be trained. Full functioning requires an unrestricted motion range of the tongue. However, it is important to not overestimate, and equally important to not underestimate a restricted tongue mobility caused by tongue-tie.

Additionally, maxillary and buccal frenula are not connected to a muscular hydrostat and they do not affect a gross structure. The required movements of the upper lip and the buccal frenula are minimal during breathing, breastfeeding, eating and speech. Thus, there is generally no anatomical indication for revision of the maxillary and never for buccal frenula.

Márta Guóth-Gumberger: conceptualization, writing – original draft, methodology, validation, writing – review and editing. Daniela Karall: conceptualization, writing – review and editing, methodology, validation, writing – original draft.

The authors declare no conflicts of interest.