Tongue-Tie Surgery: Everything You Need to Know

"Tongue-tie," or ankyloglossia, is a congenital condition in which the lingual frenulum (a thin fold of tissue that connects the bottom of the mouth to the underside of the tongue) is abnormally short or tight, causing impaired tongue mobility. Tongue-tie surgery releases the lingual frenulum to allow for proper extension and movement of the tongue.

Tongue-tie surgery may be indicated if the lingual frenulum does not recede or loosen over time and it restricts tongue movement enough to interfere with an infant's, child's, or adult's health or quality of life.

When considering tongue-tie surgery for yourself or your child, it's important to learn about the different techniques used and what you can realistically expect as an outcome from the surgery.

What Is Tongue-Tie Surgery?

Tongue-tie surgery is usually performed by an otolaryngologist, dentist, oral surgeon, or pediatrician.

There are three different types of tongue-tie surgeries: frenulotomy, frenectomy, and frenuloplasty.

Frenulotomy

A frenulotomy (a.k.a. a frenotomy) involves simply releasing or "clipping" the lingual frenulum.
The healthcare provider makes a single cut through the frenulum using sterile scissors or a scalpel.

This surgical procedure is classically used to treat infants with a tongue-tie who are having trouble nursing. Since this procedure is extremely quick, anesthesia is not necessary.

Frenectomy

During a frenectomy, the entire lingual frenulum is removed with a scalpel. General or local anesthesia may be used.

Frenuloplasty

A frenuloplasty is generally indicated if the lingual frenulum is thick, posteriorly located (back of the tongue), or if a prior tongue-tie procedure failed.

During a frenuloplasty, the healthcare provider uses a sterile scalpel and/or scissors to release the lingual frenulum from the tongue. While there are slightly different ways to perform a frenuloplasty, all aim to lengthen the front part of the tongue by closing the resulting wound in a particular pattern using sutures.

A frenuloplasty may be done under local or general anesthesia.

Alternative Surgical Techniques

For the above tongue-tie surgeries, instead of using scissors or a scalpel to cut the lingual frenulum, the healthcare provider may use a laser or electrocautery (using electricity to heat and cut) to remove the tissue.

While all of these techniques have been found to be safe and effective, the laser and electrocautery techniques may be associated with less immediate bleeding, swelling, and pain.

Contraindications

Every patient should be evaluated for contraindications for each type of tongue tie surgery being considered.

As an example, relative contraindications for an infant frenulotomy include:

• Bleeding disorder
• Neuromuscular disorder
• Hypotonia (decreased muscle tone)
• Abnormal positioning of the jaw (retrognathia)
• Undersized lower jaw (micrognathia)

Healthcare providers may carefully weigh any surgery involving general anesthesia in very young children based on age alone.

Potential Risks

Risks associated with tongue-tie surgery are rare but include:

• Excessive bleeding
• Infection
• Damage to the tongue or salivary glands
• Scarring that can lead to reattachment of the frenulum to the base of the tongue
• Reaction to anesthesia (if applicable)
• Oral aversion
• Airway obstruction

Purpose

The main purpose of tongue-tie surgery is to increase tongue mobility.

The surgery may be indicated in infants, children, or adults with the following health issues:

• Difficulty latching in infants that is not improving with the help of a lactation consultant
• Articulation problems (difficulty pronouncing certain types of sounds) in school-age children that is not improving with speech therapy
• Mechanical issues in older children and adults (e.g., problems with oral hygiene from not being able to clean food debris from the teeth)
• Practical and social issues in older children or adults (e.g., trouble licking ice cream or kissing)
• Local discomfort

If you or your infant or child is being accessed for tongue-tie surgery, the healthcare provider will perform a medical history and physical exam focused on the mouth.

Specifically, the practitioner will access how well you (or your baby/child) can lift the tongue, stick the tongue out, and move the tongue from side to side.

The degree or severity of tongue-tie will also be evaluated, as this may help guide the treatment plan (like whether a surgical procedure is indicated and, if so, which one).

If you and your healthcare provider decide to proceed with tongue-tie surgery, further medical clearance will probably only be needed if you are undergoing general anesthesia. This clearance can usually be accomplished through a visit with your pediatrician or primary care physician.

How to Prepare

Once you or your child is scheduled for tongue-tie surgery, your practitioner will give you instructions on how to prepare.

Location

A tongue-tie surgery may be performed in a healthcare provider's office, hospital, or same-day surgical facility.

Food and Drink

Avoid eating, or giving any food to your child, after midnight on the eve of your surgery if undergoing general anesthesia. Clear liquids (e.g., water or Gatorade) may be allowed up to two hours prior to your scheduled arrival time.

For babies, formula and breastfeeding is typically allowed up to six and four hours, respectively, before the scheduled arrival time.

To minimize any stress the food and drink restrictions may cause, surgery in very young children is generally scheduled early in the morning.

Medications

You may be advised to give your child Tylenol (acetaminophen) about 30 to 60 minutes prior to the procedure if they are undergoing no or local anesthesia.

Adults or older children will be advised to stop taking certain medications, like Glucophage (metformin), angiotensin receptor blockers, or nonsteroidal anti-inflammatory drugs (NSAIDs), for a designated period of time before the procedure.

For most other medications (e.g., acid reflux medication), patients can usually take them on the morning of their surgery, but be sure to double-check with your practitioner first.

What to Wear and Bring

If you or your child is undergoing general anesthesia, be sure to wear something that can be easily changed out of, as changing into a hospital gown is required. Something loose-fitting is best, as it will help add to your comfort when you change back into your clothes to head home after the surgery.

Do not wear makeup, nail polish, or deodorant.

Bring your insurance card. For your infant or child, bring a pacifier, bottle, favorite stuffed animal, and/or blanket to help soothe them after the procedure is over.

Pre-Op Lifestyle Changes

For adults undergoing general anesthesia, stop smoking as soon as possible prior to surgery.

What to Expect on the Day of the Surgery

Here is what you can expect during a tongue-tie surgery, from start to finish.

Before the Surgery

Upon arrival at the hospital, healthcare provider's office, or surgical facility, you will be led into a small pre-operative/holding area.

If general anesthesia is planned (only done in a hospital or surgical facility), you/your child will change into a hospital gown. A nurse will then record your/your child's vitals.

For older children or adults, an intravenous (IV) line will be placed into a vein in their arm. This IV will be used for administering medications during the procedure.

Your practitioner will then come to greet you and briefly review the surgery. You may need to sign a consent form at this time.

Before going into the operating room, your child may be given a sedative to help them relax and, sometimes, fall asleep. Younger children may receive the sedating medication through a mask whereas older children may receive it through their IV. Once asleep, any child who does not have an IV will have one placed by a nurse.

From there, you or your child will walk into the procedure/operating room or be wheeled there on a gurney (if given a sedative).

In some cases, one parent or guardian may be allowed to accompany their child into the operating room for the start of anesthesia. This decision is left up to the anesthesiologist. For the remainder of the procedure, parents will wait in the waiting room.

If your infant is undergoing a frenotomy (which is usually done without anesthesia), they will be carried by a nurse into the procedure room while you wait behind in the waiting area.

During the Surgery

The exact steps of the surgery depend on which tongue-tie procedure is being performed.

That said, you can generally expect the following:

Anesthesia Administration

For procedures involving general anesthesia, an anesthesiologist will administer inhaled or intravenous medications to render you or your child temporarily unconscious. Once it has taken full effect, the anesthesiologist will insert an endotracheal (breathing) tube into the trachea (windpipe). The breathing tube is connected to a ventilator.

If your infant is undergoing a frenotomy, the healthcare provider usually administers a sucrose solution or oral sucrose, which has been shown to decrease pain response in infants. In some cases, a topical numbing gel may be also be applied inside the baby's mouth.

Infant Restraint

Restraint may be needed for an infant undergoing a frenotomy.

Three main methods are used to ensure your child is appropriately restrained:

• Swaddling
• Using a papoose board (board with six wings that wrap to completely immobilize your child)
• Having an assistant holding the baby's or child's head for support.

Keep in mind that the purpose of the restraint is to keep your child safe. Therefore, it's OK and common for babies to be fussy and crying during a frenotomy. The good news is that the procedure is so quick that your baby will be back in your arms before you know it.

Procedure

The steps taken to release the lingual frenulum are as follows:

• Frenulotomy: The healthcare provider will hold the tongue upward so it's pointing toward the roof of the mouth. Then, the lingual frenulum will be cut in a single motion fairly close to the tongue. This will leave behind an open wound that will heal on its own.
• Frenectomy: The lingual frenum is completely removed. Two incisions are made—one at the upper aspect and one at the lower aspect of the lingual frenulum. A diamond-shaped wound is left behind on the underside of the tongue. Resorbable sutures are used to close this wound. Additional sutures are placed along the floor of the mouth.
• Frenuloplasty: The lingual frenulum is removed using more precise, complex incisions, and the wound is closed in a specific pattern. Resorbable sutures are used to close the incisions.

After the Surgery

Right after surgery, the infant's mother will be asked to breastfeed or bottle-feed. Feeding helps soothe the baby and encourages tongue mobility.

Know, however, that if your baby had local anesthesia, latching on or sucking may be a bit of a struggle for the first 30 minutes or so, as the numbing medication wears off.

If you (or your child) underwent general anesthesia, you will be taken to a recovery area to slowly wake up. Once the staff considers you or your child fully awake, alert, and ready, they will approve a discharge and send you home with post-operative instructions.

Recovery

After a tongue-tie surgery, you can expect a small amount of bleeding and pain in the mouth.

For pain management, your healthcare provider may recommend Tylenol (acetaminophen). Motrin (ibuprofen) may be recommended if your child is at least 6 months of age.

Following any tongue-tie surgery, normal feedings and diets can be resumed, unless a local anesthetic was used. In this case, your practitioner will advise you to opt for soft foods and refrain from hot drinks until the numbing medication has completely worn off.

Wound Care

After a tongue-tie surgery, a diamond-shaped wound will be present in the mouth.

If the wound is left open, it will have a yellow-to-white coloring to it. This is normal, and there is usually nothing to do in terms of cleaning the wound. That said, some healthcare providers may recommend that older children and adults rinse their mouth out with salt water several times a day, starting the day after the procedure.

After a frenectomy or frenuloplasty, stitches may be placed. These stitches will dissolve on their own or be removed about one week after the surgery.

Exercises

You or your child will need to perform various tongue stretching exercises several times a day for around four to six weeks after the procedure.

The purpose of these exercises is to strengthen the tongue muscle, improve tongue range of motion and coordination, and lessen the chances for any tissue reattaching or any scar tissue forming.

Exercises will vary based on the age of the patient, surgeon preference, and the type of procedure that was performed.

If your infant underwent tongue-tie surgery, you will need to manually manipulate their tongue for them in order to perform these exercises. It's best to do this just before or after a diaper change. Always wash your hands with soap and water first.

Long-Term Care

After a tongue-tie surgery, mothers often notice an immediate improvement in their baby's comfort during feeding; although, some babies may take more time to adjust. Do not hesitate to reach out to a lactation consultant or feeding specialist for extra guidance, if needed.

For older children who undergo tongue-tie surgery for articulation problems, significant improvement can be seen within one to three weeks after the procedure. Keep in mind though, many children need to continue speech therapy after surgery, as they adjust to their more mobile tongue.

Possible Future Surgery

A second tongue-tie surgery may be warranted if a tongue-tie reattaches or recurs from scar tissue formation. Tongue-tie may be more likely to recur after a frenotomy than after a frenectomy or frenuloplasty.

A Word From Verywell

While there is absolutely no way to prevent a tongue-tie, the good news is this condition can be effectively treated, if needed, with minimal discomfort.

If you are considering a tongue-tie procedure for yourself or your child, be sure to review your decision carefully with multiple healthcare providers (e.g., pediatrician, lactation consultant, otolaryngologist, speech-language pathologist, etc.)

As with any surgery, there are risks involved, so you want to be certain the procedure will be helpful and that less invasive means (if possible) have been exhausted first.