Tongue-Ties

What is Tongue Tie?

2205460717_dfc69c7163_oTongue tie, or ankyloglossia, is when the frenulum (membrane under the tongue) which connects the tongue to the floor of the mouth is too short.  Because of this, the tongue is often unable to extend (stick out) past the lips.  In infants, this can effect the baby’s ability to properly “latch” and breast feed.

In older children, it can effect speech, swallowing, and the formation of the jaw.  Although tongue-tie occurs in varying degrees of severity, some form of it can effect up to 5% of all babies.

What is Frenotomy?

Often referred to as ‘tongue clip’, Frenotomy (also called frenulotomy or frenulectomy) is the procedure in which the lingual frenulum (membrane connecting tongue to floor of mouth) is cut. It is done when the frenulum seems unusually short or tight (anklyoglossia or “tongue-tie”). Often, frenotomy may be recommended when the frenulum is impairing the infant’s ability to breastfeed.

How is it Done?

The procedure involves lifting the tongue toward the roof of the mouth, applying gentle pressure to the tongue frenulum (the tongue tie) then dividing (cutting) the frenulum. The cut is made in a single motion in less than a second. Anesthesia is not necessary. The only risk is excessive bleeding. Normally, there is only a drop of blood or less.

This leads to an immediate release of tethering (tightness) and an increase in tongue mobility. This procedure can be performed in the office for younger children (typically less than 3 months of age).

Procedures for older children are performed in the operating room under anesthesia.

A special tongue elevator makes the procedure easy, but the tongue may also be lifted with the index and middle fingers on either side of the frenulum, and the frenulum clipped with sterile scissors.

In very rare circumstances, the upper lip also may have a frenulum (lip tie) that is so severe that it limits movement of the lip and can lead to feeding difficulties. Uncommonly, this also will require a procedure similar to the tongue frenotomy to release the ‘lip tie’.

The procedure is safe, but there are very small risks of bleeding and injury to the saliva ducts that are under the tongue. There also is a very small risk of scarring that may require repeat surgery.

History of the Tongue Tie Release

This procedure dates back to the 18th century, when it was fairly common for midwives to cut the frenulum with a sharp fingernail. Doctors of that time also began recommending it for infants with breastfeeding difficulties. Although occasionally controversial, many doctors believe,when indicated, frenotomy in the newborn period can quickly improve a “poor latch” on the breast, and prolong the mother’s ability and willingness to breastfeed.

*These images courtesy of Janelle Aby MD at Stanford School of Medicine