Tongue-tie: Morphogenesis, Impact, Assessment and Treatment busts the myths associated with tongue-tie that prevent the re-establishment of routine assessment and treatment of the condition in the early postpartum period. Dr. Hazelbaker provides both the old and new evidence that enables clinicians to properly assess, diagnose and treat this genetic condition that creates so many problems with inf
ant feeding, speech and orofacial development. Dr. Hazelbaker presents the embryological and physiological underpinnings of tongue-tie, discusses tongue-tie’s impact, provides information on assessment and classification then rounds out her book with research-based treatment options and guidelines. She weaves in her personal story, having been tongue-tied and being the mother of two formerly tongue-tied children, as well as the stories of many other families into the science, creating both a readable and credible book. Tongue-tie: Morphogenesis, Impact, Assessment and Treatment is the definitive book on tongue-tie that will serve health professionals and policy-makers worldwide as they endeavor to change the clinical culture surrounding this common but underappreciated problem. This book takes the reader on a journey through the literature, past and present, related to tongue-tie issues and controversies; reflects on areas of prior dispute; and, based on the research from the last fifteen years, assists the reader in coming to a new understanding of tongue-tie. Chapter One defines tongue-tie within the total framework of ankyloglossia and its various manifestations, while adhering to the age-old Conceptual Definition of tongue-tie, first framed more than two millennia ago. This chapter distinguishes the Conceptual Definition of tongue-tie from its various Operational Definitions and discusses the role these Operational Definitions play in expanding our understanding of tongue-tie. Chapter One also includes a brief examination of tongue-tie as a syndrome of its own, presenting incidence statistics in various populations. This morphofunctional foundation provides the background against which tongue-tie and its impact can be thoroughly understood and appreciated. Chapter Three presents the normal anatomy and physiology of the tongue and of infant suck, focusing on the tongue’s unique role. This chapter also includes an examination of tongue-tie and ankyloglossia as a sign/symptom of congenital anomalies; it does not address the anomalies themselves, but views tongue-tie within this larger physiological frame. A discussion of the impact tongue-tie has on infant feeding, swallowing, oral toilet, airway integrity, speech, and orofacial/dental development appears in Chapters Four and Five. Extensive citation of the literature supports the assertions made, with an emphasis placed on the role tongue-tie plays in breastfeeding difficulties. Photos (with brief commentary) of the various presentations of tongue-tie and its impact on orofacial development appear in a special section between these chapters. Chapter Six addresses the tongue-tie assessment process, emphasizing function over appearance. A presentation of the development and use of the Assessment Tool for Lingual Frenulum Function (ATLFF) and the Tongue-Tie Assessment Protocol (TAPP) appears alongside that of the more abbreviated forms of assessment found in the literature. This chapter discusses the strengths and weaknesses of each process and the common pitfalls of assessment, including the ability or inability of any given assessment process to help the clinician make a differential diagnosis. This chapter also identifies problems associated with developing a standardized treatment decision rule. Chapter Seven thoroughly presents the various treatment options, with an emphasis on frenotomy. This chapter clarifies the types of treatment available (frenotomy, frenectomy, frenuloplasty, stripping, clipping, laser, and others), the safety and efficacy of each method, and the indications for choosing one particular method over another. A discussion of the need for postoperative treatment, such as suck training and speech therapy, follows. This chapter also answers common clinical questions about the postoperative treatment course: How is suck–swallow–breathe disorganization handled in the infant? How is tongue weakness corrected? How do you feed the infant after tongue-tie correction? What happens if you delay treatment? What therapeutic methods assist with postoperative recovery and the re-establishment of optimal tongue function in all age groups? The Afterword examines any remaining objections to the routine assessment and treatment of tongue-tie in infancy. It proposes areas for further contemplation, especially where controversy still strongly asserts itself. It also suggests areas for future research and proposes strategies for making health care providers and the public more familiar with tongue-tie. Each chapter closes with a Chapter Takeaway. This segment is designed to provide an accessible summary for readers whose exposure to the more technical aspects of the tongue-tie discussion has been limited. Professional readers may choose to share the summary information with adult clients who may be facing an immediate decision about surgical intervention and therapy, either for a child or for themselves. Such a nutritious snack may be all that is needed to sate a parent’s need for information. Appendix A provides brief answers to frequently asked questions. Appendix B lists various resources for parents and professionals, including organizations that provide breastfeeding help and contact information for practitioners willing to perform frenotomies, especially for posterior ties. Appendix C provides historical information on the development of the Assessment Tool for Lingual Frenulum Function, instructions for the assessment process, and an up-to-date assessment chart. Appendix D provides finger-feeding instructions; a glossary and extensive bibliography round out the book—arming the reader with the tools to better inform the skeptical colleagues who are least likely to read this volume. In addition, the citations can serve as a foundation for written institutional policies. It is time for a change—one that will enable all tongue-tied individuals to easily receive the care they need. I hope this book will finally put to rest the myths and misunderstandings that still define the topography of this subject’s landscape. There is no benefit to keeping the old arguments alive. The last 15 years have produced more good literature on tongue-tie than the preceding 100 years of inquiry. We now have answers: good ones. Now that we do, minds need to change so that clinical practice also can change.
