Tongue Tied

Tongue Tied

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Tongue-tie typically affects boys more often than girls.
Tongue-tie is not the only reason for breastfeeding difficulty.
Surgical treatment of tongue-tie may not improve breastfeeding.
Tongue-tie does not cause speech delay, but can affect a child’s speech articulation —the ability to form sounds and pronounce words.
Tongue-tie diagnoses are increasing as breastfeeding becomes more commonplace.

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The tongue attaches to the floor of the mouth with a web of tissue called the lingual frenulum. Tongue-tie, or ankyloglossia, is an inborn variation in this structure. The lingual frenulum may be shortened or thickened, restricting movement of the tongue, or it may tether the tongue too close to the tip.
Tongue-tie may affect an infant’s ability to latch effectively during breastfeeding and can cause maternal symptoms during breastfeeding, as well. Rarely, tongue-tie may cause mechanical difficulties in the child’s speech and oral hygiene.
Variations in the underside of the tongue and how it attaches to the floor of the mouth are common and most are not cause for concern.
Tongue-tie may be suspected in infants or children who have difficulty with the following:
The Coryllos ankyloglossia grading scale is a system for noting the type of tongue-tie.
A thorough evaluation considers not only the Coryllos grade, but also how well the child’s tongue is able to move. The Hazelbaker assessment tool for lingual frenulum function (HATLFF) or a similar tool, can be used to assess tongue function.
An otolaryngologist specializing in pediatrics can provide guidance to concerned parents. If the main complaint is difficulty in breastfeeding, a lactation consultant or infant feeding expert can help assess breastfeeding and provide non-surgical interventions.
If tongue-tie is interfering with feeding, speech or oral hygiene or if it is causing discomfort, treatment may be appropriate.
Frenotomy (also called frenulotomy) is a surgical procedure to release the frenulum so the tongue can move more freely. Most babies can feed immediately afterward.
Frenuloplasty is for more complex cases of tongue-tie or for revision procedures, and involves plastic surgery of the frenulum. Speech therapy and tongue exercises may be part of the recovery process.
While the procedures are, in general, safe, there are risks that can occur with frenulum procedures, including severe bleeding, infection, injury to the salivary ducts, and worsening breathing. A child should be assessed for possible contraindications to a frenotomy procedure.
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Anatomy and Development of the Mouth and Teeth

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Tongue-tie (ankyloglossia). American Academy of Otolaryngology-Head and Neck Surgery. http://www.entnet.org/content/tongue-tie-ankyloglossia. Accessed Feb. 13, 2018.
Isaacson GC. Ankyloglossia (tongue-tie) in infants and children. https://www.uptodate.com/contents/search. Accessed Feb. 14, 2018.
Chinnadurai S, et al. Treatment of ankyloglossia for reasons other than breastfeeding: A systemic review. Pediatrics. 2015;135:e1467.
Baker AR, et al. Surgical treatment of ankyloglossia. Operative Techniques in Otolaryngology. 2015;26:28.
Walsh J, et al. Diagnosis and treatment of ankyloglossia in newborns and infants. JAMA Otolaryngology-Head and Neck Surgery. 2017;143:1032.
O'Shea JE, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systemic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011065.pub2/abstract. Accessed Feb. 14, 2018.

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Tongue-tie is typically diagnosed during a physical exam. For infants, the doctor might use a screening tool to score various aspects of the tongue's appearance and ability to move.
Treatment for tongue-tie is controversial. Some doctors and lactation consultants recommend correcting it right away — even before a newborn is discharged from the hospital. Others prefer to take a wait-and-see approach.
The lingual frenulum may loosen over time, resolving tongue-tie. In other cases, tongue-tie persists without causing problems. In some cases, consultation with a lactation consultant can assist with breast-feeding, and speech therapy with a speech-language pathologist may help improve speech sounds.
Surgical treatment of tongue-tie may be needed for infants, children or adults if tongue-tie causes problems. Surgical procedures include a frenotomy or frenuloplasty.
Tongue-tie (ankyloglossia) is a condition in which an unusually short, thick or tight band of tissue (lingual frenulum) tethers the bottom of the tongue's tip to the floor of the mouth. If necessary, tongue-tie can be treated with a surgical cut to release the frenulum (frenotomy). If additional repair is needed or the lingual frenulum is too thick for a frenotomy, a more extensive procedure known as a frenuloplasty might be an option.
A simple surgical procedure called a frenotomy can be done with or without anesthesia in the hospital nursery or doctor's office.
The doctor examines the lingual frenulum and then uses sterile scissors to snip the frenulum free. The procedure is quick and discomfort is minimal since there are few nerve endings or blood vessels in the lingual frenulum.
If any bleeding occurs, it's likely to be only a drop or two of blood. After the procedure, a baby can breast-feed immediately.
Complications of a frenotomy are rare — but could include bleeding or infection, or damage to the tongue or salivary glands. It's also possible to have scarring or for the frenulum to reattach to the base of the tongue.
A more extensive procedure known as a frenuloplasty might be recommended if additional repair is needed or the lingual frenulum is too thick for a frenotomy.
A frenuloplasty is done under general anesthesia with surgical tools. After the frenulum is released, the wound is usually closed with sutures that absorb on their own as the tongue heals.
Possible complications of a frenuloplasty are similar to a frenotomy and are rare — bleeding or infection, or damage to the tongue or salivary glands. Scarring is possible due to the more extensive nature of the procedure, as are reactions to anesthesia.
After a frenuloplasty, tongue exercises might be recommended to enhance tongue movement and reduce the potential for scarring.
Here's some information to help you get ready for your appointment and know what to expect from your doctor.
Prepare a list of questions ahead of time, such as:
The doctor is likely to ask you a number of questions. For example:
Preparing and anticipating questions will help you make the most of your time with the doctor.
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Tongue-tie (ankyloglossia) is a condition in which your child’s tongue remains attached to the bottom of their mouth. Symptoms include difficulty with breastfeeding and speech. A simple surgical procedure can treat the issue.

American Academy of Pediatrics. Tongue-Tie in Infants & Young Children. (https://www.healthychildren.org/English/healthy-living/oral-health/Pages/Tongue-Tie-Infants-Young-Children.aspx) Accessed 7/29/2022.
Canadian Paediatric Society. Ankyloglossia and breastfeeding. (https://cps.ca/en/documents/position/ankyloglossia-breastfeeding) Accessed 7/29/2022.
Francis DO, Chinnadurai S, Morad A, et al. Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie (https://www.ncbi.nlm.nih.gov/books/NBK299112/) [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 May. (Comparative Effectiveness Reviews, No. 149.) Executive Summary. Accessed 7/29/2022.
National Health Service. Tongue-tie. (https://www.nhs.uk/conditions/tongue-tie/) Accessed 7/29/2022.

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Tongue-tie — also known as ankyloglossia — is a condition in which a person’s tongue remains attached to the floor of their mouth . This occurs when the lingual frenulum (a thin strip of tissue connecting your tongue and the floor of your mouth) is shorter than usual. A short frenulum can restrict your tongue’s movement.
Ankyloglossia is most common in newborns and young children, but adults can have it too. It’s associated with breastfeeding (chestfeeding) difficulties and speech problems. Tongue-tie is a congenital condition, which means people are born with it.

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An anterior tongue-tie is in the front of your child's mouth near the tip of their tongue, just behind their lower teeth and gums. It often looks like a thin web. A posterior tongue-tie (sometimes called a “hidden” tongue-tie) is further back where the floor of their mouth meets their tongue, making it more difficult to see.
Anterior tongue-ties are more common than posterior tongue-ties.
Anyone can develop tongue-tie. In some cases, ankyloglossia is hereditary (meaning it runs in families). Tongue-tie mostly affects newborns and young children. But it’s possible for older children and adults to have the condition.
Ankyloglossia occurs in up to 10% of newborns (depending on the study and definition of tongue-tie).
In some instances, children learn to adjust to tongue-tie as they grow older. But if ankyloglossia is causing problems, it’s best to treat it early, as some symptoms worsen with age.
Symptoms of tongue-tie range from mild to severe. Your child's tongue may appear to be heart-shaped or may have a notch in it. In many cases, ankyloglossia is mild enough that symptoms don’t interfere with daily life.
If you're breastfeeding, you may also have symptoms related to your child's tongue-tie, including:
In young children, tongue-tie symptoms may include:
Your tongue and the floor of your mouth fuse together in the womb. Over time, your tongue separates from the floor of your mouth. Eventually, only a thin band of tissue (the lingual frenulum) connects the bottom of your tongue to the floor of your mouth.
As a baby grows, the small band of tissue under the tongue shrinks and thins. In children with ankyloglossia, the band of tissue remains thick, which makes it difficult to move the tongue.
In infants, ankyloglossia is often diagnosed by a pediatrician or a lactation consultant.
Dentists often diagnose tongue-tie in older children and adults.
The true impact of tongue-tie on speech isn't clearly understood. Your child's tongue needs contact with the roof of their mouth when pronouncing the lingual sounds “t”, “d”, “z”, “s,” “th,” “n,” and “l.” When their tongue is severely restricted and can't reach the roof of their mouth, your child can have problems with articulation (pronunciation).
Speech therapy is beneficial for many children with ankyloglossia. Tongue-tie surgery may also be necessary for optimal results.
In order to create an adequate seal when breastfeeding, your infant must extend their tongue over their jaw line. If your baby has tongue-tie, this isn't possible. They often attempt to use their gums to keep the nipple in their mouth during breastfeeding. This can be painful.
In some cases, tongue-tie isn't severe enough to cause noticeable symptoms. Infants and young children who have tongue-tie but don't have problems with feeding, swallowing or speaking may not need treatment.
If your child has tongue-tie and has trouble feeding, their healthcare provider can perform a tongue-tie surgery in which they cut their lingual frenulum. This is called a frenectomy (also known as frenulectomy, frenotomy or tongue-tie division). It's often performed without sedation on infants.
Tongue-tie surgery causes minimal discomfort for infants. Young children and adults may receive pain medications or general anesthesia before the procedure.
As with any surgical procedure, a tongue-tie procedure carries risks of complications, including:
Left untreated, moderate to severe cases of tongue-tie can cause problems including:
Since people are born with tongue-tie, there’s no way to prevent it. For more severe cases of tongue-tie, early diagnosis and treatment are key to a successful recovery.
Most infants and children with tongue-tie recover completely with minor surgery and/or speech therapy. Some may not need treatment at all.
If your baby has a tongue-tie, here are some questions you may want to ask their healthcare provider:
Tongue-tie is a relatively common condition that can lead to potential feeding problems or speech issues. People who are born with tongue-tie may improve without treatment over time. But tongue-tie surgery is necessary in most cases. During this simple procedure, your child's surgeon clips their lingual frenum, allowing their tongue to move freely and without restriction. Tongue-tie surgery is a straightforward way to ease ankyloglossia symptoms. Ask your child's healthcare provider about treatment options and timelines.
Last reviewed by a Cleveland Clinic medical professional on 07/19/2022.

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