# Stunted girl: A heartbreaking case report of underdiagnosed and untreated posterior ankyloglossia

## TL;DR

A case report shows how untreated posterior tongue-tie in a child led to stunted growth and developmental issues, which could have been prevented with early diagnosis and surgery.

## Contribution

Highlights the underdiagnosed and severe impact of posterior ankyloglossia on child development and the role of plastic surgeons in addressing it.

## Key findings

- Posterior ankyloglossia can cause stunting, speech disorders, and swallowing difficulties in children.
- Surgical frenotomy improved tongue mobility and may prevent developmental delays.
- Posterior ankyloglossia is rare, hard to diagnose, and often overlooked as a cause of growth issues.

## Abstract

Plastic surgeons can help to eliminate stunting by surgically treating children born with congenital craniofacial anomalies such as tongue-tie, or ankyloglossia. Releasing ankyloglossia can help to support breastfeeding and the later development of orofacial anatomy and physiology. Failure to do so can lead to growth and development difficulties in children. We report a heartbreaking case of a stunted 8 year-old female with underdiagnosed and untreated ankyloglossia.

The patient was consulted with a short stature, speech disorder, and swallowing disorder. History taking and physical examination led to a diagnosis of type 4 (posterior) ankyloglossia. The Hazelbaker Assessment Tool for Lingual Frenulum Function mandated a frenotomy. Under general anesthesia, frenotomy was performed surgically, and significant tongue mobility was gained.

This case alerted both surgeon and pediatrician that collaboration is a must to intervene in such a specific congenital anomalies. Posterior (type 4) ankyloglossia may cause difficulties in tongue mobility which can lead to difficulties in breastfeeding and swallowing, speech disorders, and malocclusion. Posterior ankyloglossia is not only the most severe form of ankyloglossia, but also the most difficult to diagnose.

In the absence of social and environmental factors, posterior (type 4) ankyloglossia was the single most responsible factor in this growth and development delay in the girl. Timely diagnosis and treatment could have prevented such a stunted condition.

•Plastic surgeon may contribute to growth and development of children by diagnosing and treating ankyloglossia.•Posterior ankyloglossia is rare and difficult to diagnose.•Failure to treat ankyloglossia may result in short stature, speech disorder, and poor daily performance.

Plastic surgeon may contribute to growth and development of children by diagnosing and treating ankyloglossia.

Posterior ankyloglossia is rare and difficult to diagnose.

Failure to treat ankyloglossia may result in short stature, speech disorder, and poor daily performance.