Tongue Tie

Tongue-tie is a condition present at birth that restricts the tongue's range of motion.

With tongue-tie, 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, so it may interfere with breastfeeding. Someone who has tongue-tie might have difficulty sticking out his or her tongue. Tongue-tie can also affect the way a child eats, speaks, and swallows.

Causes

Typically, the lingual frenulum separates before birth, allowing the tongue free range of motion. With a tongue-tie, the lingual frenulum remains attached to the bottom of the tongue. Why this happens is largely unknown, although some cases of tongue-tie have been associated with certain genetic factors.

Treatment

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 breastfeeding, 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.

Frenotomy

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.

Frenuloplasty

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.