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Tongue-Tie (Ankyloglossia)

The tongue attaches to the floor of the mouth with a web of tissue called the lingual frenulum. Tongue-tie, or ankyloglossia, is an inborn variation in this structure. The lingual frenulum may be shortened or thickened, restricting movement of the tongue, or it may tether the tongue too close to the tip.

Tongue-tie may affect an infant’s ability to latch effectively during breastfeeding and can cause maternal symptoms during breastfeeding, as well. Rarely, tongue-tie may cause mechanical difficulties in the child’s speech and oral hygiene.

What You Need to Know
  • Tongue-tie typically affects boys more often than girls.
  • Tongue-tie is not the only reason for breastfeeding difficulty.
  • Surgical treatment of tongue-tie may not improve breastfeeding.
  • Tongue-tie does not cause speech delay, but can affect a child’s speech articulation —the ability to form sounds and pronounce words.
  • Tongue-tie diagnoses are increasing as breastfeeding becomes more commonplace.

Tongue-Tie Diagnosis

Variations in the underside of the tongue and how it attaches to the floor of the mouth are common and most are not cause for concern.

Tongue-tie may be suspected in infants or children who have difficulty with the following:

  • Breastfeeding
  • Lifting their tongue
  • Sticking the tongue out (the tongue may appear notched or heart-shaped when the child attempts to do so)
  • Moving the tongue from side to side
  • Licking their lips or sweeping food debris from the teeth

The Coryllos ankyloglossia grading scale is a system for noting the type of tongue-tie.

  • Type I: The frenulum is thin and elastic, and anchors the tip of the tongue to the ridge behind the lower teeth.
  • Type II: The frenulum is fine and elastic, and the tongue is anchored 2 – 4 millimeters from the tip to the floor of the mouth close to the ridge behind the lower teeth.
  • Type III: The frenulum is thick and stiffened, and anchors the tongue from the middle of the underside to the floor of the mouth.
  • Type IV: The frenulum is posterior or not visible, but when touching the area with the fingertips, the examiner can feel tight fibers anchoring the tongue, with or without a thickened, shiny surface on the floor of the mouth.

A thorough evaluation considers not only the Coryllos grade, but also how well the child’s tongue is able to move. The Hazelbaker assessment tool for lingual frenulum function (HATLFF) or a similar tool, can be used to assess tongue function.

An otolaryngologist specializing in pediatrics can provide guidance to concerned parents. If the main complaint is difficulty in breastfeeding, a lactation consultant or infant feeding expert can help assess breastfeeding and provide non-surgical interventions.

Tongue-tie Treatment

If tongue-tie is interfering with feeding, speech or oral hygiene or if it is causing discomfort, treatment may be appropriate.

Frenotomy (also called frenulotomy) is a surgical procedure to release the frenulum so the tongue can move more freely. Most babies can feed immediately afterward.

Frenuloplasty is for more complex cases of tongue-tie or for revision procedures, and involves plastic surgery of the frenulum. Speech therapy and tongue exercises may be part of the recovery process.

While the procedures are, in general, safe, there are risks that can occur with frenulum procedures, including severe bleeding, infection, injury to the salivary ducts, and worsening breathing. A child should be assessed for possible contraindications to a frenotomy procedure.

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