Why the Long Face?...

A tongue tied person walks into a bar....

The bartender asks him, "Why the long face?"

The tongue tied person says, "Because I'm tongue tied!"


People with Long Faced Syndrome have long, narrow faces. Their faces grow vertically more than horizontally. Now, there are multiple symptoms and physical traits associated with long faced syndrome of which ankyloglossia is just one. I myself have long faced syndrome and have many of the symptoms associated with it.

In most cases of long faced syndrome, the child suffers with allergies and/or an obstruction of the upper airways. Not being able to breathe through their nose, the child breathes through his/her mouth. In order to maintain an open airway, their tongues sit low in their mouths to allow air to pass, their chins are held down and back, and they lean their heads forward. Over time, this posturing leads to more vertical than horizontal growth.

This girl has the typical long faced 'posture': Open lips, chin drawn back, head leaning forward...

Long Faced Syndrome. Notice the open lips. More on that below...

Again, open lips...

Continued mouth breathing leads to inflamed tonsils making breathing more difficult... and thus maintaining open mouth breathing. Sometimes, the tonsils are enlarged due to infection and that leads to mouth breathing. Whichever came first, the child is at risk for developing long faced syndrome.

Those with long faced syndrome due to allergies often have dark circles under their eyes - known as allergy 'shiners'. They may also have narrow nostrils and have difficulty achieving a lip seal - meaning their lips are perpetually apart (see pictures). They likely have sleeping difficulties, including snoring and sleep apnea symptoms, and excessive daytime sleepiness.

I'd like to emphasize here that children can develop sleep apnea as well as adults, which is why breathing difficulties need to be taken seriously. Do you like the idea of your child's breathing stopping while they sleep? Didn't think so. So if you see your child with their mouth always open and their tongue hanging out it's time to call the doctor. NOW.

Tongue tie plays a role in developing long faced syndrome as well. For one, a tongue tie puts a lot of vertical tension on the face, pulling muscles down and limiting their horizontal movement. I myself had difficulty maintaining a smile while I was tongue tied. The cheeks and mouth are pulled down leading to a pouty, hangdog expression... which I myself had! Also, ankyloglossia keeps the tongue low in the mouth encouraging mouth breathing which begins the cycle of inflamed tonsils and facial posturing leading to more vertical facial development.

Now, let me take a moment here to clarify that there is nothing wrong with having a long face in and of itself. There are many beautiful people, including celebrities, who have long faces...

"Don't hate us because we have long faces..."

What I'm talking about is a syndrome of symptoms and physical traits that lead to discomfort and impaired functioning. Unattractive features are just the surface of this syndrome. And I look at myself when I say that...

Mouth breathing. Dark circles. A pouty, unhappy expression. I've had all of these... and they did not look good. I hated breathing through my mouth because I knew it was unattractive and made me look stupid. Now, thanks to a lingual frenectomy and myofunctional therapy, I can breathe through my nose, have diminished allergy symptoms, sleep well, no longer have excessive daytime sleepiness, and I'm much happier with what I see in the mirror. I will always have a long face but I can present myself in a more attractive fashion because I have dealt with one of the contributing factors of my long faced syndrome.

What is really interesting about issues with breathing, allergies, facial development, and tongue tie is how interrelated they all are. Allergies affect breathing, sleep, and facial development. Airway obstructions (such as polyps or abnormal bone growth) affect breathing, sleep, and facial development. Having a tongue tie affects breathing, sleep, and facial development.

So, any one of these symptoms can throw things off balance, which is why people should be aware that one symptom can lead to several. Maybe not right away, but over time.

As always, consult with a doctor about any symptoms you or your loved one may have.

Happy Trails!