SECT. XXIX.—ON CONSTRICTION OF THE TONGUE, OR TONGUE-TIED PERSONS.
The affection called ancyloglossus is sometimes congenital, the membrane which fastens the tongue being originally harder and more constricted than ordinary; but sometimes is acquired from some hard cicatrix formed under it by ulceration. Those therefore who have this affection naturally are distinguished by being slow in beginning to speak, and by having the frænum linguæ larger than its moderate size, and that without any previous ulceration. When the complaint is occasioned by a cicatrix it is easily recognised. Wherefore the patient is to be placed on a proper seat, the tongue raised to the roof of the mouth, and the membranous frænum cut transversely. But if the curvature is occasioned by a cicatrix, we transfix the callus with a hook and draw it upwards, and making a cross incision free the bent part, taking care not to make deep incisions of the parts; for hemorrhages which have been found difficult to stop have thereby been occasioned. After the operation the part is to be washed with cold water or oxycrate; and after all these things the cure is to be completed with relaxing and incarnative applications.
Commentary. Celsus thus describes the treatment in congenital affections: “Horum extrema lingua vulsellâ prehendenda est, sub eâque membrana incidenda, magnâ curâ habitâ, ne venæ quæ juxta sunt, violentur et profusione sanguinis noceant.” (vii, 12, 4.)
Aëtius’s plan of treatment is quite similar to our author’s. (viii, 38.)
Albucasis gives a similar account of the operation. He cautions against opening the artery below the tongue, for fear of hemorrhage. Should this accident occur he directs the surgeon to use the actual cautery. (Chirurg. ii, 34.)
Rhases recommends when the frænum extends to the tip of the tongue that it be divided, so as to allow freedom of motion. However, one of the authorities quoted by him directs us to pass through the frænum a needle armed with a thread, which is to be tightened so as to divide the intermediate space. He recommends this method in order to obviate the fear of hemorrhage from the incision. Rhases himself states that a dangerous hemorrhage will result from opening the green veins below the tongue. (Cont. vii, 1.)
Avicenna also recommends the operation with the ligature. (iii, vi, 11.)
Haly Abbas describes very distinctly the operation of dividing the frænum. (Pract. ix, 35.)
Alsaharavius mentions that the operation is sometimes necessary. (Pract. ix, 35.)