Tongue Tie (Ankyloglossia) Patient Information

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What is the lingual frenulum (or frenum)?

The lingual frenulum is a thin fold of mucous membrane that extends from the underside of the tongue to the floor of the mouth. It is an embryological remnant that partially regresses during fetal development.

What are the functions of the lingual frenulum?

The lingual frenulum does not have any significant physiological function. It is thought to play some role in stabilizing the tongue and preventing posterior prolapse (rolling to the back of the throat). In children with craniofacial deformities or with retrognathia, the lingual frenulum may play a larger role in preventing upper airway obstruction and sleep apnea.

What is tongue tie (ankyloglossia)?

Tongue-tie (ankyloglossia) is a condition which restricts the movement of the tongue. It is usually present at birth or becomes more prominent as the child grows. It is typically characterized by a short, tight, and/or thickened band of mucosa and tissue that tethers the tongue and limits the tongue’s ability to protrude (stick out).

How does a tongue tie (ankyloglossia) typically present?

A common presentation is the inability to protrude the tongue past the upper gum line. In severe cases, a characteristic V-shaped notch at the tip of the tongue is noted when it is protruded. Patients may also have difficulty touching the roof of the mouth and moving the tongue from side to side.

In most cases, a tongue tie does not cause any problems when it is mild. However, a short or tight frenulum may lead to problems with breastfeeding in infants. This includes difficulty latching, pain with breastfeeding, and poor weight gain.

In toddlers and children, speech abnormalities related to articulation may be present around the age of three. The child may have trouble with articulation of the sounds - l, r, t, d, n, th, sh, and z. A gap between the two lower incisors may be present in a severely prominent frenulum.

What should you expect during your visit with your ENT doctor for tongue tie (ankyloglossia)?

During your visit, your ENT doctor will perform a complete history and physical exam to evaluate the severity of the tongue tie. Typically, no additional workup is needed.

How is tongue tie (ankyloglossia) treated?

In most cases, a tongue tie does not cause any problem when it is mild. Close observation to allow the frenulum to “loosen” is reasonable. In toddlers and older children, speech therapy may be necessary if there is evidence of speech abnormalities. When indicated, surgery may be necessary to release the tongue tie.

When is surgery (frenotomy or frenuloplasty) indicated?

Surgery for a tongue tie (ankyloglossia) is controversial, especially if there are no apparent problems. In infants with evidence of tongue tie and associated difficulty feeding, a simple in-office procedure called a frenotomy can be performed without the need for anesthesia. In older children with tongue tie and an associated speech abnormality, a frenotomy or a frenuloplasty can be performed with local anesthesia or general anesthesia. When indicated, these simple procedures can yield significant improvement in patients who are symptomatic.

Learn more about frenotomy and frenuloplasty for tongue-tie.