Tongue tie surgery involves separating the lining that connects the mouth to the tongue, known as the frenulum. It is a surgery to treat tongue tie, which is when the frenulum is unusually short or tight.
Tongue tie, also known as ankyloglossia, is a condition in which the lingual frenulum — a piece of mucosa connecting the tongue and the base of the mouth — is too thick or short and impairs movement. This often first becomes evident during breastfeeding.
The cause is unclear, and treatment is only necessary if the thick frenulum causes problems with mouth function. Tongue tie division is the surgery of choice to repair a tongue tie after consultations have not resolved it.
Some doctors refer to tongue tie division as frenotomy, frenulotomy, or tongue tie release. These terms refer to a procedure where a surgeon
Variations of this procedure include frenuloplasty, which involves using extra tissue to lengthen the frenulum, or frenulectomy, in which the surgeon removes the tissue altogether. No current guidelines state that one procedure is better than another, but a pediatric surgeon will judge based on the benefits and risks.
Typically, a doctor may only recommend a frenotomy for infants experiencing problems due to tongue tie. According to a
Functional issues due to tongue tie might include:
- issues with breastfeeding, including difficulty with attaching, or latching, to the nipple or staying latched
- long, very frequent feeding periods
- excessive dribbling while feeding
- choking or coughing during feeds
- making clicking noises during feeds
- consuming only small amounts of milk while feeding
- finding weight gain difficult or losing weight
- excessive gassiness
People who have infants with tongue tie may have painful breasts with swelling or sore nipples.
Often, doctors recommend the procedure if conservative treatments have not successfully addressed the tongue tie. These might include watching to see whether breastfeeding becomes easier, consulting about lactation issues, or seeing a speech-language specialist about the issue, per a
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Several steps may be necessary to help an infant prepare for a tongue tie division.
First, they should feed around 30 to 60 minutes before the appointment to be ready to feed immediately after. For those under 8 weeks of age, a parent can bring 30 milliliters (mL) of expressed breast milk. Those over 8 weeks of age can take infant paracetamol. Children over 5 months old may benefit from age-appropriate teething gel.
Once a parent brings their child to the appointment, a medical professional will assess how the baby’s tongue moves. They will help the parent feel their child’s frenulum and explain wound management and aftercare.
Generally, the infant will not receive anesthesia, as this could mean the child’s tongue is too numb for them to feed afterward. Instead, they may receive sugar water with no anesthesia. However, they may require anesthesia if the doctor removes the entire frenulum or if they are an older child.
The medical professional and their team may carry out a tongue tie division in
- They will swaddle the baby to restrict movement.
- A surgical assistant will hold back the baby’s shoulders with their hand and use their wrist to keep the baby’s head stable.
- The surgeon will use a device to hold the tongue out of the way.
- They will divide the frenulum using sharp scissors with blunt ends or a laser.
It is an in-office procedure, meaning an infant can return home the same day. Doctors carrying out frenuloplasty or frenulectomy will use anesthesia.
The only significant benefit of the procedure in infants is improved breastfeeding, according to a
Some older children and adolescents may also require the procedure. A
However, the review found that evidence did not support a concrete conclusion about whether a frenotomy during infancy would benefit a child’s speech or breathing later on.
Side effects of frenotomy
- bleeding
- airway obstruction
- injury to salivary glands
- oral aversion
- scarring
However, frenotomy is a simple procedure, and complications are rare.
After the procedure, people will require follow-up consultations to check progress with breastfeeding. The United Kingdom’s National Health Service recommends:
- breastfeeding at least twice hourly for a week
- avoiding the use of pacifiers and bottles
- offering top-ups if necessary through finger feeding or techniques involving a feeding tube at the breast, which a healthcare professional will explain
The healthcare team will explain several exercises that may help loosen restricted muscle movements in the face. They may also recommend massaging the wound, which will first appear as a small, red, diamond-shaped scar and then shrink and turn white during healing, for about 6 weeks.
A person may perform the massage twice daily for 6 seconds. The produce involves the following steps:
- The parents should clean their hands and dry the area under the tongue.
- Lay the infant down on a firm surface, supporting their head in the palm with the thumb on one ear and the smallest finger in the other.
- Using the free hand, place a thumb underneath the baby’s chin and an index finger under the tongue, moving the tongue as far back as possible.
- Sweep the finger gently under the tongue, move it directly to the wound, and apply firm, wiggling pressure for 6 seconds.
- Repeat the sweeping motion at the end of the massage.
Perform this for 7 to 10 days. Once the diamond turns white, a parent will need to perform a different massage to stretch the scar. After repeating steps two and three:
- Sweep the finger across the bottom of the tongue.
- Place the finger in front of the scar horizontally.
- Stretch the scar up and down using the finger pad for around 6 seconds.
- Repeat the sweep.
Perform the scar-stretching massage twice daily for about 5 weeks until the scar is flat and soft.
Tongue tie division, or frenulotomy, is a simple procedure where a surgeon cuts the lingual frenulum to treat tongue tie. It is specifically helpful for treating problems with breastfeeding due to a thick lingual frenulum that makes moving the tongue difficult.
The procedure is most common in infants, although older children and teens may also need it if they still have tongue tie. During a frenulotomy, the doctor snips the lingual frenulum with scissors. Parents should start breastfeeding again more frequently immediately after the procedure and will need to perform daily massages for several weeks to support wound healing.