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Apr 13 2019

Rethinking Tongue Tie Anatomy: Anterior vs Posterior Is Irrelevant

#anterior #definition #anatomy


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There is no doubt that tongue-tied children have a higher propensity for breastfeeding difficulty. In trying to understand how best to treat children with tongue tie, practitioners have developed a classification system to describe tongue tie.

Most practitioners use a classification where the tongue tie is given a grade of 1, 2, 3, or 4. Classically, class 1 and 2 are thought of as anterior. whereas class 3 and 4 are posterior. Unlike cancer grading, where stage 1 is minimal disease and stage 4 is severe disease, that distinction does not apply for grading the severity of tongue ties. Instead, the tongue tie classification system is merely a description of where the tie attaches to the tongue. I have seen class 4 babies with severe breastfeeding problems and class 1 babies who feed normally, and vice versa. The problem with the word “posterior” is that those unfamiliar with this classification may erroneously think that the tongue tie is in the back of the throat, back by the tonsils. Better descriptive terms would be submucosal or hidden tongue ties, but we are unfortunately stuck with the term posterior.

Class 1 Tongue Tie. This is the classic heart-shaped tongue that most doctors feel is the only real tongue tie. The tie inserts into the tip of the tongue.

Class 2 Tongue Tie. Considered to be an anterior tie, this tie inserts just behind the tip of the tongue. We don’t see a heart-shaped tongue, but the tie is still clearly seen.


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