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Table of Contents
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 23-25

Complete ankyloglossia associated with an impacted tooth: A rare case report

1 Department of Oral Maxillofacial Surgery, Azeezia Dental College, Kollam, India
2 Department of Paediatric and Preventive Dentistry, Noorul Islam College of Dental Sciences, Neyattinkara, Trivandrum, India
3 Excel Multispeciality Dental Clinic, Kollam, Kerala, India

Date of Submission17-Feb-2022
Date of Acceptance03-Mar-2022
Date of Web Publication25-Mar-2022

Correspondence Address:
Dr. Roopesh U Nair
Department of Oral Maxillofacial Surgery, Azeezia Dental College, Kollam 691537, Kerala.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/INJO.INJO_2_22

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Introduction: Developmental disturbances of the tongue can harmfully distress the development of the surrounding structures. We report a rare type of non-syndromic, complete ankyloglossia associated with impacted permanent posterior tooth and its surgical intervention. Case Presentation: An 18-year-old female patient having main complaint of difficulty in moving tongue was found to have Class IV ankyloglossia according to Kotlow’s classification with impacted 44. Management: Surgical frenectomy under general anesthesia was done, and follow-up after 6 months revealed tension-free movements and betterment in speech. Conclusion: Ankyloglossia impairs functions, for example, mastication, speech, and swallowing. This case report offers guidelines which can be used for therapy of a tongue constraint consequential from complete ankyloglossia and impacted tooth.

Keywords: Ankyloglossia, impaction, non-syndromic

How to cite this article:
Nair RU, Usha AM, Vishwanath V, Ambika S, Khan S. Complete ankyloglossia associated with an impacted tooth: A rare case report. Int J Oral Care Res 2022;10:23-5

How to cite this URL:
Nair RU, Usha AM, Vishwanath V, Ambika S, Khan S. Complete ankyloglossia associated with an impacted tooth: A rare case report. Int J Oral Care Res [serial online] 2022 [cited 2022 May 25];10:23-5. Available from: https://www.ijocr.org/text.asp?2022/10/1/23/340922

  Introduction Top

Ankyloglossia is a tongue developmental anomaly exhibiting a strangely short, thick lingual frenum that limits tongue movement. Putting it another way, tongue-tie ensues when the lingual frenulum is located close to the tongue tip, limiting tongue mobility.[1] Due to a short frenulum lingua, Wallace defined tongue-tie as an ailment, which, in the tip of the tongue, is not in a position to protrude past the lower incisor teeth. The prevalence of tongue-tie differs reliant on the population considered, ranging from 0.2% to 5%.[2] With a male-to-female ratio of 2.5:1.0, males are more affected than females.

There are two types of ankyloglossia: partial and complete ankyloglossia. Partial ankyloglossia is defined as the occurrence of a sublingual frenulum that alters the appearance and/or function of the infant’s tongue due to its decreased length, lack of elasticity, or attachment too distal underneath the tongue or too close to or onto the gingival ridge, according to the Academy of Breastfeeding Medicine Protocol. Ankyloglossia complete is a very rare condition wherein the tongue as well as the floor of the mouth fuse together completely.[3] Surgical reduction of the frenum is recommended if the anomaly is severe enough to cause mechanical as well as functional difficulties, followed by speech therapy for immediate lingual muscle rehabilitation.[3]

Several surgical techniques for correcting an abnormal frenulum have been described in recent years. In dentistry, the following techniques are particularly interesting: using one hemostat, two hemostats, a groove director, or a laser, frenotomy, and frenectomy are performed.

  Case Report Top

A female patient within the age group of 18 years consulted to our OPD with chief complaints of difficulty in moving tongue and in pronouncing certain words. Thorough medical history was taken and on examination large tongue with its lower border attached to the missing 44 regions with Class IV ankyloglossia [Figure 1], according to Kotlow’s classification. Orthopantomagram (OPG) was taken and impacted 44 was noticed [Figure 2]. The patient was suggested for surgical frenectomy under general anesthesia. Patient’s written consent was taken and posted for surgery. The patient prepared and draped under nasotracheal intubation. Local infiltration was given using lignocaine with adrenalin in the ratio 1:200,000. Incision was placed over the attachment of 44 regions and then dissection was done through the safe plane and tongue was released to expose the floor of the mouth. Wharton’s duct opening was identified as well as secured safely, and vertical incision was given over the lingual frenum from the ventral surface of the tongue to the lingual mucosa. The dissection was carried out into the lingual frenum up to the genioglossus muscle layer. Later, tongue was detached from the lingual mucosa, preserving the duct up to the muscle layer. Tongue movements were checked in all directions which confirmed the tension-free movements. Closure of ventral surface and floor of the mouth were done using 3-0 Vicryl. Patient’s extubation was uneventful. The patient was advised for speech therapy and orthodontic correction of impacted 44 and anterior open bite. Follow-up after 6 months revealed good tension-free movements and betterment in speech [Figure 3].
Figure 1: Pre-operation

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Figure 2: OPG showing missing 15 and impacted 44

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Figure 3: Post-operation

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  Discussion Top

Tongue is a vital tissue affecting speech, position of the teeth, periodontal tissue, nutrition, as well as swallowing. Ankyloglossia is a congenital abnormality of the lingual frenulum. Speech problems result due to limited flexibility of the tongue as a result of ankyloglossia. The hitches in pronunciation are apparent for consonants as well as sounds alike “s, z, t, d, l, j, zh, ch, th, d,” besides it is specifically tough to roll an “r”.[4] The relation amid altered frenum as well as speech disorders were recorded as statistically significant with P< 0.001.[5] There is not much proof that ankyloglossia may be a genetically transmissible pathology.[6] It is still not known regarding the genetic components regulating the phenotype as well as penetrance in the patients affected.

The incapability to elevate the tongue to the roof of the mouth might avert the progress of an adult swallow and reassure the development of an infantile swallow, resulting in an open bite. Gingival recession on the lingual surfaces of the lower anteriors, mandibular prognathism, along with maxillary hypodevelopment, is all caused by the tongue’s low position and forward as well as downward pressure.[7] The pathophysiology of tongue-exact ties is unidentified. The mucosa that covers the front two-thirds of the mobile tongue comes from the first pharyngeal arch, abnormal frenulum length as well as attachment, which are almost certainly the result of a deviation from normal development. Ankyloglossia is thought to be a one-time occurrence in most children. This physical finding has been linked to numerous syndromes, comprising Ehlers–Danlos syndrome, Beckwith–Wiedemann syndrome, Simosa syndrome, X-linked cleft palate, and orofaciodigital syndrome.[8]

  Kotlow’s Classification of Ankyloglossia Top

The length of the tongue from the insertion of the lingual frenum into the base of the tongue to the tip of the tongue is known as the free tongue. The normal range of free tongue is more than 16 mm in clinical practice. Ankyloglossia can be classified into four types, according to Kotlow, based on the clinically accessible free tongue (protrusion of tongue).[9]

  • Class I: Mild ankyloglossia (12–16 mm)

  • Class II: Moderate ankyloglossia (8–11 mm)

  • Class III: Severe ankyloglossia (3–7 mm)

  • Class IV: Complete ankyloglossia (<3 mm).

  • In the standard range of motion of the tongue that must be determined utilizing Kotlow’s criteria, which vacillate from Class I to Class IV, the most important factor to consider is ankyloglossia. The tip of the tongue ought to be capable to protrude outside the mouth minus clefting, and the upper as well as lower lips must be incapacity to be swept lacking strain. The tongue should not blanch the tissue lingual to the anterior teeth when it is retruded, nor should it exert excessive forces on the mandibular anterior teeth when it is retruded. The Hazelbaker assessment tool could be used to determine the tongue’s functional movement along with appearance.[10] Each movement of the tongue and the appearance of the tongue are given scores in this tool. The surgical invention should be considered if the functional and appearance scores are less than 11 and 8. Even a well-compensated ankyloglossia in an edentulous mouth might necessitate surgical correction preceding the fabrication of full dentures.

    Ankyloglossia of the labial frenum has also been encountered in a child with deciduous molar dentition oligodontia.[11] Ankyloglossia was found to be associated with an impacted permanent posterior tooth in this case, which has never been reported before. It is suspected that tongue-tie may often resolve spontaneously by late childhood,[12] but in our patient, he was a 20-year-old male in which tongue-tie was found to be persistent since birth. However, the patient did not seek treatment until he started having social concerns regarding the condition.

      Conclusion Top

    It is critical that patients receive accurate information and guidance regarding the indications as well as probable advantages of tongue-tie revision. Because there are no acknowledged practical norms for the management of such an ailment, this article intends to bring together all of the information on tongue-tie examination, diagnosis, treatment, and management for a better clinical approach.

    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


    Conflicts of interest

    There are no conflicts of interest.

      References Top

    Kotlow LA. Ankyloglossia (tongue-tie): A diagnostic and treatment quandary. Quintessence Int 1999;30:259-62.  Back to cited text no. 1
    Darshan HE, Pavithra PM. Tongue-tie: From confusion to clarity—A review. Int J Dent Clin 2011;3:48-51.  Back to cited text no. 2
    Bhattad MS, Baliga MS, Kriplani R. Clinical guidelines and management of ankyloglossia with 1-year followup: Report of 3 cases. Case Rep Dent2013. doi: 10.1155/2013/185803  Back to cited text no. 3
    Reddy NR, Marudhappan Y, Devi R, Narang S. Clipping the (tongue) tie. J Indian Soc Periodontol 2014;18:395-8.  Back to cited text no. 4
    [PUBMED]  [Full text]  
    Olivi G, Signore A, Olivi M, Genovese MD. Lingual frenectomy: Functional evaluation and new therapeutical approach. Eur J Paediatr Dent 2012;13:101-6.   Back to cited text no. 5
    Saeid M, Mobin Y, Reza R, Ali AP, Mohsen G. Familial ankyloglossia (tongue-tie): A case report. Acta Medica Iranica 2010;48:123-4.   Back to cited text no. 6
    Hughes CL, Bass JW. The oral-facial-digital syndrome: Report of a case. Oral Surg Oral Med Oral Pathol 1966;22:265-71.  Back to cited text no. 7
    Chu MW, Bloom DC. Posterior ankyloglossia: A case report. Int J Pediatr Otorhinolaryngol 2009;73:881-3.   Back to cited text no. 8
    Chaubal TV, Dixit MB. Ankyloglossia and its management. J Indian Soc Periodontol 2011;15:270-2.  Back to cited text no. 9
    [PUBMED]  [Full text]  
    Johnson RV. Tongue-tie—Exploding the myths. Infant 2006;2:96-9.  Back to cited text no. 10
    Rana RE, Puri VA, Thakkur RK, Baliarsing AS. Median cleft of mandible and lower lip with ankyloglossia and ectopic minor salivary gland on tongue. Indian J Plast Surg 2004;37:67-70.  Back to cited text no. 11
    Lalakea ML, Messner AH. Ankyloglossia: Does it matter? Pediatr Clin North Am 2003;50:381-97.  Back to cited text no. 12


      [Figure 1], [Figure 2], [Figure 3]


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