Tongue-tie, also known as ankyloglossia, is a condition in which the thin piece of tissue (lingual frenulum) connecting the underside of the tongue to the floor of the mouth is shorter than usual, which can limit the tongue's movement. This can make it difficult for an affected individual to speak, swallow, or breastfeed.

Tongue-tie is present at birth and can be diagnosed during a physical examination by a healthcare provider. Tongue-tie is relatively common, affecting approximately 4% of newborns, and is more common in males than females.

In infants, tongue-tie can make breastfeeding difficult and painful for both the baby and the mother. The baby may have difficulty latching onto the nipple, which can result in inadequate milk intake and poor weight gain. In older children and adults, tongue-tie may cause difficulty with speech or swallowing, and can also lead to dental and orthodontic problems.

Treatment for tongue-tie may involve a simple surgical procedure to cut the lingual frenulum (frenotomy) or to release it (frenuloplasty). This is usually a quick and safe procedure that can be performed in a doctor's office or hospital. After the procedure, patients may experience some pain and discomfort for a few days, but typically recover quickly and can resume normal activities.

It is important to note that not all cases of tongue-tie require treatment, and treatment decisions should be made in consultation with a healthcare provider.

Typically, the lingual frenulum separates before birth, allowing the tongue free range of motion. With 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 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.

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.

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.