What is Tongue Tie?

Tongue tie (also known as Ankyloglossia) is a congenital condition where the tongue is tethered to the floor of the mouth.  This tethering is by a membrane (frenulum) in the middle of the tongue.  Tongue tie may be diagnosed in newborn infants who are having trouble feeding, or in older children who are learning to speak.

Tongue tie occurs in about 3-4% of infants and is slightly more common in boys than girls.  This condition may be inherited genetically or may be a new finding that no one else in the family has had.

Ankyloglossia (pronounced ang"ku-lō-glô'sē-u) is diagnosed by performing a physical examination to evaluate the mobility of the tongue.  By lifting the tongue off of the floor of mouth, the frenulum can be visualized.  There are varying degrees of tongue tie, and in the most severe case the frenulum connects the tip of the tongue to the inner border of the mandible (jaw).  Other findings on examination include inability for the child to lift the tongue to the roof of the mouth, a “heart-shaped” appearance to the front of the tongue and difficulty with protrusion of the tongue.

What Problems Does Tongue Tie Cause?

In newborn infants with tongue tie, the most common symptoms are feeding problems.  Most often, there is difficulty with latching on during breast feeding, which is found in up to 85% of infants with ankyloglossia.  Other problems include poor sucking, ineffective milk transfer and fatigue within a few minutes of starting feeding.  Mothers often experience significant nipple pain (described as the infant “chomping” on the breast) or erosions on the nipple with breastfeeding.  The cumulative effect of the difficulty, frustration and pain with nursing may lead to abandoning breastfeeding. Infants fed with a bottle can also experience slow feeding, excess dribbling during feeding, or swallowing air.

In older children, tongue tie can cause problems with speech and pronunciation.  Studies have shown that children with tongue tie have significantly more articulation errors than children without tongue tie.  Tongue tie will not cause speech delay, however.  Other problems older children may experience include problems with eating (like licking an ice cream cone), dental problems and problems playing musical instruments.

How is Tongue Tie Treated?

Treatment of ankyloglossia is a relatively straightforward surgical procedure called a “frenulotomy” or “frenuloplasty”.  This procedure releases the frenulum to allow the tongue to move normally. 

In newborns and young infants this procedure can be done in the office and does not require a general anesthetic.  Frenulotomy is extremely effective in treating feeding problems associated with tongue tie in newborns.  In infants who are breast fed, problems with latching on and poor suck resolve immediately about 75% of the time, and most of the remainder improve in the next 48 hours.  Mothers also typically experience immediate relief in the pain associated with breastfeeding after the procedure and are able to nurse the baby immediately after the procedure.  Feeding problems due to tongue tie in bottle fed infants typically improve after the procedure. There is a minimal amount of bleeding during the procedure, which stops easily with a short period of pressure.  There have been no serious complications described for frenulotomy or frenuloplasty.

In toddlers the procedure is generally done in the operating room as a brief outpatient procedure.  During the procedure, the frenulum is exposed, clipped with scissors and several stitches are placed to close the incision and permit better tongue extension. There is no significant pain after the procedure and the child is able to eat immediately.

In older children with speech problems due to ankyloglossia, at least 75% have improvements in articulation problems after the frenuloplasty.  Ongoing speech therapy may be needed to correct residual problems and is usually more successful once the tongue has been released.

Top of Page                     CSSD Division of Otolaryngology