Tongue Tie Surgery

Understanding The Need For Surgery To Treat Tongue Tie

infant tongue tie, newborn tongue tie, tongue-tie
Poor Feeding May Indicate Tongue-Tie Surgery Is Needed.

What is Tongue-Tie?

Tongue-tie is an unusual term for a common childhood problem.  In a child said to be “tongue-tied” the piece of tissue under the tongue is too tight, too thick or too short.  This tissue, known as the lingual frenulum, helps control movement of the tongue and helps with swallowing, feeding and speech.  If it is too short or restricts movement of the tongue, newborns and infants may have difficulty getting enough food.

Tongue tie is present at birth, and in many cases will become less of a problem as a child grows.  Some children may have a short, thick or tight lingal frenulum without being “tongue-tied”, in these cases the condition is not an issue that needs to be addressed.

Children who are tongue tied will often have difficulty sticking out their tongue, or they may be unable to do so.  They may also have difficulty lifting their tongue up toward the roof of their mouth.  Simple tasks, like licking an ice cream cone, may be difficult.

Who Is a Candidate For Tongue-Tie Release Surgery

Many physicians prefer to “wait and see” if tongue-tie resolves on its own rather than performing surgery on newborns or infants.  Unless there are special circumstances, most will wait until the child is at least one year old before considering surgical treatment. 

When Surgery For Tongue-Tie May Be Necessary

Your child may need a tongue-tie release, called a lingual frenectomy or frenotomy, surgery if they are experiencing:

Difficulty Feeding: If a newborn or infant is having ongoing difficulty with feeding, particularly breastfeeding, there may be an issue with tongue-tie.  A frenulectomy (tongue-tie release) may be considered if it is believed to be the cause of the issue.  

Poor Weight Gain: In some children, there may be no obvious difficulty with feedings, but they are not gaining the amount of weight that they should.

  They may appear to be feeding enough, but they are not taking in enough food to grow as expected.  

Trouble Swallowing: Tongue-tie can cause difficulties with the tongue motions that assist in swallowing.  This may be seen as drooling, gagging or coughing when trying to feed. 

Speech Problems: In older children who are eating well, speech difficulties may be the first sign of tongue-tie.  Tongue-tie can result in a lisp or other issues.  Typically, a speech pathologist can determine if surgery can correct the issue and make a recommendation for surgery.

Difficulty With Oral Hygiene: Tongue-tie can make it difficult to brush teeth and floss well.  This can lead to cavities and other dental issues.

Adults and Tongue-Tie Surgery

Some adults find out that they are tongue-tied after many years of dealing with difficulty swallowing, kissing or even speech issues. The procedure to correct the issue can be performed on adults, although most people have this done in early childhood, many adults do have the surgery. The procedure is much more common in children, so do not be surprised if the individual performing the surgery is a specialist in pediatric medicine rather than adult.

Risks of Frenectomy (Tongue-Tie Release)

  • Pain
  • Bleeding
  • Infection
  • General Risks of Anesthesia

How Tongue Tie Surgery Is Done

The procedure to release a tongue-tie, known as a frenectomy, is a quick one, typically lasting less than 15 minutes.  In the past, the procedure was often performed at a dentist’s office. It is now more common to have the surgery in a physician’s office or as an outpatient surgery with anesthesia.

In most cases, a cautery tool is used, although a surgical scalpel is also appropriate.  This is a hand held tool with a tip that uses heat to cut through tissue rather than a sharp blade.  This tool helps to minimize bleeding because the tissue is both cut and cauterized at the same time.

  The tight frenulum (tissue holding the tongue down) is cut, freeing the tongue.  Some patients may have a few stitches in the area, and others may have no need for stitches and will be allowed to heal without them.  The stitches may be the type that dissolves or may have to be removed a week or so later.

After Tongue Tie Surgery

Patients may have some minor pain after the procedure but can typically return to their normal eating habits immediately.  Newborns and infants are able to breast and bottle feed immediately, and if anesthesia is used children may eat and drink once they are awake enough to do so safely.


 Tongue-tie, breastfeeding difficulties and the role of frenotomy. Kumar, M. and Kulke, E. Accessed July 2015.

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