Tongue-Tie – Diagnosis and Treatment
Diagnosis
Doctors usually confirm ankyloglossia by looking inside the mouth and checking the lingual frenulum—the thin tissue connecting the tongue to the floor of the mouth.
They may use a gloved finger or a tongue depressor to gently lift the tongue and assess its mobility and the shape of the frenulum.
In some cases, doctors use standardized assessment tools to score tongue function based on appearance, movement, and impact on feeding or speech.
Common signs include feeding issues, speech problems, or nipple pain during breastfeeding in infants. Doctors look for symptoms like:
- Limited tongue movement
- Trouble latching or feeding
- Thick or tight frenulum
- Clicking sounds while nursing
- Poor weight gain in infants
- Speech challenges in older children
- Difficulty sticking the tongue out or lifting it toward the upper teeth
If needed, a referral to a lactation consultant, pediatric speech therapist, or ENT (ear, nose, and throat) specialist may be made for a more in-depth evaluation.
A clear diagnosis helps determine whether a simple observation, feeding support, or a minor surgical procedure (frenotomy) may be appropriate.
Treatment
Simple Release (Frenotomy)
A healthcare provider can treat tongue-tie with a simple release procedure called a frenotomy. The provider examines the thin tissue (lingual frenulum) under the tongue and quickly cuts it using sterile scissors or a soft tissue laser.
This procedure usually takes place in a clinic or at the bedside for newborns. Most babies feel only mild discomfort because the area has few nerves and blood vessels.
If bleeding occurs, it is usually very minor, often just a drop or two. Babies can often breastfeed right after the procedure. Most people do not need anesthesia, but providers may use it for older children or adults.
Possible problems after a simple release:
- Minor bleeding
- Risk of infection
- Damage to the tongue or nearby glands
- Scarring or the tissue growing back
These issues are uncommon. A soft tissue laser can reduce bleeding and speed up healing, but not every clinic has this option.
Advantages:
| Fast Healing | Minimal Pain | Quick Procedure |
|---|---|---|
| Yes | Yes | Yes |
Surgical Repair with Stitches (Frenuloplasty)
If the tissue under the tongue is too thick, or a simple release does not work, doctors may perform a more detailed surgery called frenuloplasty.
This surgery usually takes place in a surgical setting and often requires general anesthesia, especially for children.
During frenuloplasty, the provider releases the tight tissue and closes the wound with dissolvable stitches. This technique can help infants, older children, or adults, depending on their needs.
Doctors may choose this surgery if problems occur after a simple release or if the tongue-tie is severe.
Risks and possible effects:
- Slight bleeding or infection
- Potential injury to the tongue or glands
- Scarring (more common because of stitches)
- Reactions to anesthesia
After surgery, doctors often recommend tongue exercises. These exercises can help improve tongue movement and reduce the chance of scar tissue forming.
Some people, like those who play wind instruments or need precise tongue movement for speech, may benefit from these exercises.
Comparison Table:
| Procedure | Anesthesia Needed | Recovery Time | Scarring Risk |
|---|---|---|---|
| Simple Release | Sometimes | Fast | Low |
| Surgical Repair | Usually | Moderate | Slightly higher |
Getting Ready for Your Visit
Steps You Can Take Beforehand
Before seeing the doctor or pediatric dentist, make a list of topics you want to discuss. Writing down your concerns and questions can help you stay organized during the visit.
Here are some ideas to guide you:
- Ask about how serious the tongue-tie is and if treatment is needed.
- Find out what kinds of treatments are available.
- Learn about possible surgical options, including risks and if anesthesia is used.
- See if the procedure can be done in the office or if a different setting is needed.
- Ask if you need to see other specialists, like an ear, nose, and throat doctor.
- Bring notes about any trouble with breastfeeding or speech.
Consider bringing a support person. An extra set of ears can help you remember what the provider says.
Questions the Doctor May Ask
The doctor or pediatric dentist may ask about specific issues. It helps to think about these ahead of time.
Some common questions include:
| Concern | Example |
|---|---|
| Breastfeeding challenges | Trouble latching or feeding |
| Speech or dental concerns | Problems making sounds, cleaning teeth |
| Activities affected | Trouble eating, speaking, or playing |
If you prepare for these questions, you can give clear information to your provider. This will help you get the most out of your visit.
