Tongue-Tie & Frenulectomy

Tongue-tie, also known as ankyloglossia, occurs when the membrane beneath the tongue is unusually short, thick, or tight.

No, we’re not talking about the “you’ve-just-bumped-into-the-love-of-your-life” type of tongue-tied. We’re talking about the ankyloglossia version. Ankylo-what, you ask? Yes, trying to say that word alone is probably enough to get you tongue-tied. Though getting tongue-tied can happen to even the most eloquent of us, in babies they tend to happen for a different reason.

Baby with tongue tie

What is a Tongue-Tie?

A tongue-tie refers to a band of tissue called the lingual frenulum that causes abnormal restriction to tongue movements. This membrane is found beneath the tongue and helps to tether and stabilize the tongue to the floor of the mouth. While the frenulum is a normal part of anatomy, in babies with a tongue-tie, this band is unusually short, thick, or tight. The result is a tongue that is anchored too tightly to the bottom of the mouth.

Ankyloglossia is a congenital condition, meaning babies are born with it. While some cases are only mild and don’t cause significant problems, tongue-tie can be associated with:

  • Difficulties with latching and breastfeeding, leading to poor weight gain
  • Affected speech development, as tongue movements are important for making certain sounds
  • An underbite, due to pressure on the jaw from an abnormal tongue position
  • Obstructive sleep apnea due to increased mouth breathing and abnormal development of the mouth anatomy
  • Poor dental hygiene as the tongue is unable to effectively sweep out food from around the mouth

Untreated tongue-ties in older children or even adults can interfere with a number of other activities, such as licking an ice cream, swallowing, and playing wind instruments.

Tongue-ties are found in around 4-5% of the population and are more common in boys. Doctors aren’t entirely sure why it happens in some babies and not others, but there is some suggestion that genetics are involved.

A tongue-tie can be diagnosed by a number of healthcare professionals who deal with the problems caused by tongue-ties. For example, an ENT doctor, midwife, lactation consultant, speech and language pathologist, or a pediatrician would all be able to identify a tongue-tie. Diagnosis is made simply with a physical exam.

Treatment for a Tongue-Tie

As mentioned earlier, some cases of ankyloglossia don’t interfere in any significant way. There is also the potential for the frenulum to loosen and lengthen as the child grows, thereby self-resolving. The specific concerns raised by a tongue-tie may be addressed through targeted treatments, such as speech therapy or coaching with a lactation consultant. In some cases, your child may be recommended to undergo a frenulectomy.

What is a Frenulectomy?

Also known as a frenotomy, a frenulectomy is a quick in-office procedure performed by an ENT doctor. It involves the doctor snipping the offending frenulum to free the tongue, either with a laser, surgical scissors, or a scalpel. In babies under 3 months old, this is often performed without anesthesia as the frenulum contains few nerve endings and blood vessels.

It’s rare to encounter a complication of a frenulectomy, however, not impossible. Potential complications include:

  • Bleeding requiring medical attention
  • Infection
  • Scarring at the incision site
  • Refusal to feed afterward
  • Requiring a repeat procedure
  • Pain as reported by the parents

Another type of surgical treatment for tongue-tie is a frenuloplasty. This is typically for older children or in particularly thick tongue-ties that are unsuitable for a frenulectomy. Unlike a frenulectomy, frenuloplasties are performed under general anesthesia and may require stitches to seal the incision.

It should be mentioned that some healthcare professionals believe ankyloglossia to be an overdiagnosed or frequently misdiagnosed condition. This was demonstrated in a study that found out of 115 infants who were referred for a frenulum surgery due to breastfeeding problems, less than half of these ended up requiring the operation after going through feeding therapy with a pediatric speech pathologist. The timing of surgical intervention can also be controversial, with some clinicians believing it should be performed before the baby leaves the hospital while others prefer to wait to see if the issue resolves on its own.

As a parent, it can be stressful and confusing to know what’s best in the face of conflicting information. If a piece of advice doesn’t sit well with you, seek a second opinion or make sure to find a reputable doctor with extensive experience in managing ankyloglossia. A frenulectomy isn’t necessarily the answer for all cases of tongue-ties, but in many cases it can help with the problems associated with ankyloglossia.