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Newborns > Tongue Tie

Tongue Tie

Some babies are born with a short frenulum under the tongue. This inhibits the baby from extending the tongue past the lips. Many people refer to this condition as "tongue-tied" (medically called ankyloglossia).

The tongue’s frenulum attaches the tongue to the floor of the mouth.  It should allow the tongue to extend past the lower gums and lip, elevate to the roof of the mouth, and move from side to side.  If it is too thick, too short, or too far toward on the tip of the tongue it can affect feeding, speech, tooth placement, and growth of the mouth.  The official term of a frenulum that limits tongue movement is ankyloglossia, but commonly is called tongue tie.  Tongue tie affects about 4/100, more commonly in boys, and there is a 21% family history.

Treatment of tongue tie involves lifting the tongue and clipping the frenulum (frenotomy). This can be done by trained pediatricians, ENTs, or dentists.  It is recommended if the frenulum is very thick, posterior, very vascular or if there is a family history of bleeding disorders that an ENT specialist does the procedure. The frenulum does not have nerves for pain, and most newborns tolerate the procedure well without any anesthetic. If there is a problem feeding in the newborn period, some of our physicians can clip the frenulum (the part that "ties" the tongue down) and release the tongue so it can move better. We will be happy to discuss and evaluate if you feel your child will benefit from this procedure.

Risks of clipping:
 
  • Infection
  • Bleeding
  • Scar formation
  • Damage to salivary glands
  • Need for more surgery

After the clipping the underside of the tongue will get a yellowed area (called "granulation tissue"). This is the normal healing tissue and will resolve within a few days.

There are 4 types of tongue tie:
 
  • Type 1: Attachment of the frenulum is at the tip of the tongue and the base is near the gums.  It is often thin but the tongue cannot extend fully and looks heart shaped when extended.
  • Type 2: Frenulum attachment is 2-4 mm behind the tip of the tongue and its base is near the gums, but it is similar heart shaped appearance to Type 1.
  • Type 3: Frenulum attachment is mid tongue and its base is in the middle of the floor of the mouth. It is thick and inelastic. The tongue can extend but not lift, it appears squared off, cups, and bunches in the back. It can be difficult to notice.
  • Type 4: The frenulum attaches mid-tongue and its base on the floor of the mouth, but it tends to be thick, fibrous, and inelastic. It is called “posterior tongue tie”.

If you want to see a video showing how we assess tongue tie, click here. If you want to see a tongue tie release (frenotomy), click here. (We do a similar evaulation and procedure, but these not our own videos.)

Photos from Stanford.edu

Type1TongueTie.png
Type1TongueTieAfterClip.png
 The top picture is Type 1 or 2 tongue tie and the second picture is the same baby after the frenulum was clipped.

Type3TongueTie.pngType4TongueTie.png
 

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