the term ankyloglossia is derived from the greek word  agkilos  and  glossa  meaning curved and tongue respectively . also known as tongue - tie , it is a developmental abnormality in which the inferior lingual frenum is short and attached at or close to the tip of the tongue . the prime oral and general concern of this congenital abnormality is speech ( articulation of words ) , swallowing , suckling ( leads to breastfeeding problems ) and poor oral hygiene . ankyloglossia may or may not be associated with other congenital abnormalities like orofacial clefts ( i.e. , cleft lip , cleft palate ) and other craniofacial syndromes . our present case report arrays the occurrence of ankyloglossia along with cleft lip in a 12-year - old boy who was treated with a diode laser . tongue tie can be considered a relatively common anomaly with a prevalence of < 110.7% . a descriptive analysis of the prevalence of tongue lesions by patil et al . in 2013 showed 21 patients out of 4926 indian patients were affected with ankyloglossia , which accounts for 3.5% of the tongue lesions . for unknown reasons , the abnormality seems to be more common in males with a male to female ratio of 2.5:1.0 . among south indian population , a 12-year - old boy of indian ethnicity reported to the department of periodontics with a chief complaint of inability to move his tongue like all his other school friends . history revealed that he had congenital cleft lip ( not associated with cleft palate ) and was surgically treated for the same soon after birth [ figure 1 ] . on oral examination , the patient had thick inferior lingual frenum attached 3 mm from the tip of the tongue [ figure 2 ] . restricted tongue movements like protrusion , lateral movements and inability to touch the palate with the tip of the tongue were observed . on protrusion , a bifid or heart shaped tip [ figure 3 ] of the tongue was observed . according to kotlow 's classification , he was allocated under class iii  severe ankyloglossia  which accounts for the movement of the tongue between 3 mm and 7 mm . according to hazelbaker 's assessment tool , the appearance score was 2 ( which was < 8) and the functional score was 5 ( which was < 11 ) hence was indicated for frenectomy . ankyloglossia ( tongue tie ) a routine hematological examination of hemoglobin percentage , bleeding time , clotting time , random blood sugar , total leukocyte count and differential count was taken and was found to be within the normal range hence was planned for surgery . after application of topical anesthetic gel , adequate local anesthesia ( 2 ml of 0.2% lignocaine hydrochloride in 1:200,000 adrenaline ) was given as infiltration around the lingual frenum . a soft tissue diode laser of power 1 w was used to relieve the lingual frenum approaching from either side of the tissue forceps [ figure 4 ] . a 30 silk suture was used to approximate the dorsum of the tongue [ figure 5 ] . the patient was given adequate antibiotics and analgesics ( amoxicillin 250 mg tds and paracetamol 250 mg bd ) along with postoperative instructions and was asked to report after 1-week for suture removal and review . frenectomy using diode laser immediate postoperative view the hazelbaker 's appearance score after suture removal post 1-week was 10 and the function score was 12 [ figures 6 and 7 ] . the parents were instructed to consult a speech therapist for improvement in the articulation of speech . 1-week postoperative view the patient was called after 1-month for a review [ figure 8 ] . the oral consequences of ankyloglossia include restricted movement of the tongue leading to the impaired articulation of speech . l  ,  r  ,  t  ,  d  , n  ,  th  ,  sh  ,  w  and  z  is impaired . lack of sweeping action of the tongue especially in the lower lingual region may lead to oral halitosis and periodontal problems . the gingival biotype is thin due to the excessive frenal pull and may lead to midline diastema of mandibular incisors in severe cases . general consequences of ankyloglossia include social embarrassment due to disharmony of the speech , which may build up a complex within the child . tongue tie has been suggested to cause breast - feeding difficulties for both the mother and the child . suckling inability due to improper seal leads to poor infant weight gain and early weaning . mothers may experience nipple pain and/or sore nipples due to the excessive suckling pressure by the infant . however there is no standard worldwide definitive criterion used to assess the severity of ankyloglossia . clinical features of ankyloglossia are the tongue tip that can not be protruded beyond the lower gum line , abnormally short and thick frenulum and heart shaped tongue on protrusion . hazelbaker in 1993 gave an assessment tool for lingual frenum function with a scoring criteria based on which the necessity of frenectomy is decided . the perfect appearance score is given as 10 and if the appearance score is < 8 , it is indicated for frenectomy . the function score assesses the lateral movement of the tongue , extension , lifting , cupping , peristalsis and the spread of the anterior tongue . the perfect function score is given as 14 and a score of < 11 is indicated for frenectomy . class 1 or mild ankyloglossia shows movement of the tongue in between 12 mm and 16 mm . hogen et al . in 2005 explained ankyloglossia as a frenulum extending along 25100% of tongue 's total length . frenectomy , that is , incising the frenum or frenuloplasty , that is , is the surgical alteration of the frenulum can be performed in mild class 1 ( kotlow 's classification ) cases . frenectomy , that is , the complete removal of the frenum and its attachment to the underlying structure has to be performed in class ii , iii , iv cases , that is , moderate , severe and complete ankyloglossia . the benefits of laser treatment include reduced bleeding during surgery with consequent reduced operating time and rapid hemostasis , thus reducing the need for sutures . the reduced need for local anesthetics and sutures , as well as intra - operative comfort makes this technique particularly useful for very young patients . after surgical correction , patients should be referred to a speech therapist for speech modulation . while most cases of ankyloglossia are sporadic , mutations in the t - box transcription factor tbx22 may lead to heritable ( x - linked ) ankyloglossia with or without cleft lip , cleft palate and/or hypodontia . reports suggest that there is a genetic basis for the microvariation in the attachment of genioglossus muscle due to the mutations present in the tbx22 gene . in case of cleft palate with ankyloglossia ( cpx ) patients , tbx22 expression is seen in early human development , where the expression is found in the palatal shelves and is highest prior to elevation to a horizontal position above the tongue . tbx22 mrna is also detected in the base of the tongue in the region of the frenulum that corresponds to the ankyloglossia seen in cpx patients . a case report on familial ankyloglossia by morowati et al . in 2010 reported a family of five generations in which five individuals had ankyloglossia inherited as an autosomal dominant or recessive trait . another case report in 1952 describes a dutch family in which 13 persons in three generations had ankyloglossia and there were many instances of male to male transmissions . ankyloglossia or tongue - tie which may cause oral and general complications can be easily treated using frenotomy / frenuloplasty / frenectomy based on the severity of lingual attachment . the patient , however , should be referred to a speech therapist after surgical correction . it may be noted that although ankyloglossia is a sporadic developmental abnormality , it can be associated with other congenital defects such as cleft lip , both of which should be treated effectively for the general well - being of the patient . early intervention would prevent feeding problems which leads to enhanced general health , improved the oral hygiene status , accurate articulation of words and overall personality development .
ankyloglossia or tongue - tie is a congenital anomaly affecting the tongue , which is characterized by thick , short lingual frenulum . 
 this condition causes many difficulties such as limited tongue protrusion , breastfeeding difficulties , speech impairment and lack of self - confidence . 
 it is very rarely associated with any other congenital craniofacial disorders such as cleft lip , x - linked cleft palate , van der woude syndrome , smith - lemli - opitz syndrome , orofacial digital syndrome , beckwith weidman syndrome or simpson - golabi - behmel syndrome . 
 this article presents a rare case of ankyloglossia associated with cleft lip treated with diode laser in a 12-year - old indian boy who had undergone surgical correction of associated cleft lip soon after birth . 
 correction of ankyloglossia at a young age would lead to enhanced phonetics , improved oral hygiene , and overall personality development .