Tongue Tie

Tongue tie (ankyloglossia) examples

This is an example of a slightly less obvious tongue tie. This type is often missed by doctors and dentists. The tongue looks “normal,” but the full range of motion is not possible.

Info and photos from CEFAC

This is an example of an “Eiffel Tower” frenum, as it is often referred to. The frenum is in a fanned out shape where it attaches to the floor of the mouth.

This is an example of a severe tongue tie. The “heart-shape” seen on the tip of tongue is a good indication that a tongue tie is present. A thicker frenum can also be observed.

This is an example of a posterior tongue tie where it may be more difficult to identify. The tight frenum is not as apparent and the tongue seems to have more range of motion than other types of tongue ties.

Classifying the Severity of a Tongue Tie

The latest evidence linking tongue-ties to poor sleep breathing

Research from Stanford Sleep Centre now identifies children with tongue-ties as a new group of children at risk of obstructive sleep apnea. Compared to children who have enlarged adenoids and tonsils, children with restricted tongue-ties will present with breathing difficulties at a later age. This is because the changes in palate development are slowly progressive.


In another study, the same researcher emphasizes the importance of checking for tongue-ties in children with Sleep Disordered Breathing (SDB). Conversely, it suggests screening for the presence of SDB when tongue-ties are noted. The results highlight how mouth breathing often persists after the tongue-tie has been released, and myofunctional therapy to restore nasal breathing and normal breathing during sleep is often required.

All About the Tongue Tie (Ankyloglossia)

The tissue connecting the tongue to the floor of the mouth is called the lingual frenum or frenulum, and when this tissue physically restricts the mobility of the tongue, it is called a "tongue tie" or "lingual tie" or medically termed "ankyloglossia." Tissues connecting your lips and cheeks to your gums (buccal/labial frenum) may also be restricted, and these are referred to as Tethered Oral Tissues (TOTs).

The release of these tissues is often recommended for infants who are having trouble breastfeeding (after a thorough evaluation) and may also be recommended for people of all ages during therapy if necessary. Myofunctional therapy is critical before, during and after tongue-tie release surgeries to attain the greatest results and decrease your chances of reattachment.

​

There are several names for tongue-tie release surgeries, all of which have the same goal: increasing tongue mobility and improving oral function: “lingual frenotomy,” “lingual frenectomy,” “lingual frenuloplasty,” and “functional frenuloplasty,” are becoming more common for adults, as more research is showing the relation of tongue-tie and other chronic health concerns.

​

Some restricted lingual frenums are very easy to see in the mirror, but sometimes the tie is deep under the tongue and takes a trained eye to detect. This is referred to as a "posterior tongue-tie" which can affect an infant's ability to latch and can play a role in developing TMD, sleep apnea, ADHD, and several other health concerns for people of all ages.

​

Infants should always be checked for a tongue tie and other TOTs if they have difficulty breastfeeding or have GERD symptoms. A successful latch between mother and infant is challenging if not impossible when a tongue-tie is present. Poor latch causes infants to swallow great amounts of air which can cause excess bloating, vomiting, spit-up and other GERD-like symptoms, in addition to very painful circumstances for the mother. Certified lactation consultants are highly recommended for difficulties with breastfeeding, as successful breastfeeding has countless benefits for the growth and development of your child.

How can orofacial myofunctional therapy help?

After evaluating the tongue-tied patient, we will determine symptoms and function of the tongue. Based on findings, a provider will determine if a tongue frenectomy is recommended. As discussed in the next section, a frenectomy is a simple and quick surgical procedure for releasing a tight or short frenum. This is procedure can be performed by a doctor, dentist, or ENT.

It is important to start with myofunctional therapy before the frenectomy to gain strength and control of the tongue. Myofunctional exercises are necessary for proper wound healing and to help with the process of regaining full function of the tongue.

Removing the restriction alone won’t allow the orofacial muscles to function optimally. If the tongue, which is a very strong muscle, is tethered to the floor of your mouth all your life and one day it’s “let loose” — your tongue won’t know where to go! Without control of this strong muscle, your tongue will be all over the place. Post-surgical exercises are also necessary to prevent the frenum from reattaching, which would potentially require another surgery.