Ask a Doctor: Tongue Tie & Lip Tie

About Ask a Doctor

At UTHSC ENT, we understand that patients need clear, helpful answers to their questions. We also know that a flood of new information can be overwhelming.

That’s why we’ve started Ask a Doctor: an ongoing series of posts that tackle Frequently Asked Questions about common issues. We hope these articles give you a better understanding of your situation and an easy path to treatment.

Today, we’re discussing tongue & lip ties:
Prepared by: Woodi Woodland, UTHSC MS3
Reviewed by: Dr. M. Boyd Gillespie, MD, MSc, FACS

What is tongue tie?

Tongue tie is when the tissue (frenulum) that attaches the tongue to the floor of the mouth is thickened, causing it to be too short and resulting in restricted movement of the tongue. This restricted movement may lead to difficulty breastfeeding in an infant, while in older children it may present with speech difficulties.

What causes tongue tie?

Tongue tie is a congenital condition and will be present at the time of your baby’s birth. In utero as your baby develops, the tongue is initially fused with the floor of the mouth. As your baby continues to develop, the tongue should begin to separate from the floor of the mouth and will only be attached by a piece of tissue known as the frenulum. This tissue should thin and elongate as the tongue detaches. In your child with tongue tie, this tissue did not thin as expected and remained thick, resulting in a shortened frenulum.

Who is affected?

While any infant can develop tongue tie, it is more common in children born to families with a history of tongue tie. It is also more commonly seen in biological males than females.

What symptoms may your child experience with tongue tie?

There are a wide range of symptoms that can be seen in your child. These symptoms tend to evolve depending on the age of the child.

For newborns, your baby may show signs of difficulty feeding. Issues tend to be more prominent in an infant that breastfeeds versus those that feed with a bottle. You may notice your child has difficulty latching to your nipple and subsequently staying latched on. They may also make clicking noises as they feed. Their feeding sessions may be prolonged, or you may notice that your baby seems hungry all the time despite frequent feeding sessions. Your baby may also not gain weight appropriately. The breastfeeding parent may notice cracked nipples, significant pain with nursing, and a low milk supply.

If your child is older, you may notice they have difficulty pronouncing words and speech articulation. They may also suffer from frequent dental infections or poor dentition as they may not have the tongue range to clear food appropriately. And if asked to stick out their tongue, they will have trouble moving it from side-to-side or you may notice your child’s tongue forms a heart-shape.

How is it diagnosed?

Often, your child’s pediatrician will diagnose your child’s tongue tie by examining your child’s mouth and getting a detailed history from the caregivers. They may refer your child to an Ear, Nose, and Throat (ENT) specialist for further analysis.

How is tongue/lip tie treated?

Frequently, tongue tie can be treated with conservative measures. If your baby is having difficulty breastfeeding, initial work with a lactation consultant may be beneficial. If your child is having difficulty with speech, your child may be referred to work with a speech therapist.

If conservative measures fail, definitive management is with surgery. There are two surgical procedures which may be done: frenulotomy or frenuloplasty.

A frenulotomy is the initial recommendation for very young infants (~<3 months). This procedure is simply where the physician will cut the thickened tissue, or frenulum, attaching the tongue to the floor of the mouth. This procedure can be done in an outpatient setting and does not require your baby to go to sleep. This is generally because at this young age there is a smaller blood supply to this area as well as a decreased amount of nerve endings, which results in a relatively uncomplicated procedure for your child.

The other surgical option provided is a frenuloplasty. This procedure is more complex and does require your child to go into the operating room and be put to sleep. This may be done for older children or those in which a frenulotomy failed. This procedure will require the frenulum to be cut and may be closed and repaired with suture. These sutures will absorb on their own over time. Recovery after this procedure may require tongue exercises and work with a speech pathologist.

It is also important to note that your child with tongue tie may have no symptoms at all, which requires no treatment.

How can our Dream Team help?

UTHSC ENT’s Dream Team provides world class treatment in your hometown, and our pediatrics division is nationally-renowned.

If you’d like an appointment concerning your salivary stones, we’d love to hear from you!

Schedule your consultation today: 901-287-7337