What Is Tongue-Tie (Ankyloglossia)?

Tongue-tie (ankyloglossia) is a condition in which tongue movements are restricted due to a short, thick, or tightly attached band of tissue (the lingual frenulum, frenulum linguae) located on the underside of the tongue. Normally, this tissue should be thin and flexible; however, in some individuals, congenital structural differences may cause it to be shorter or tighter.

This condition is commonly referred to as “tongue-tie” and is called ankyloglossia in the medical literature. It is among the congenital conditions that ENT (Ear, Nose and Throat) specialists frequently encounter and it may lead to various problems both in infancy and later in life.

What Problems Can Tongue-Tie Cause?

By limiting normal tongue movement, tongue-tie may cause the following problems:

In infancy:

• Difficulty latching/sucking
• Insufficient weight gain
• Inability to latch onto the breast properly
• Gas pains and irritability

In childhood and adulthood:

• Speech sound difficulties (such as “l,” “r,” “t,” “d”)
• Difficulty protruding the tongue
• Changes in tooth and palate structure
• Difficulty swallowing
• Social adjustment difficulties

Mild cases of tongue-tie may cause no symptoms. In moderate to severe cases, a functional evaluation may be required.

How Is Tongue-Tie Diagnosed?

Diagnosis can be made through an ENT examination. The baby’s or child’s tongue movements, the length of the frenulum, and the shape of the tongue tip are evaluated. If needed, collaboration with a speech therapist or a lactation consultant may be considered.

How Is Tongue-Tie Surgery Performed (Frenotomy – Frenuloplasty)?

Surgical methods used in the treatment of tongue-tie include the following:

1. Frenotomy (Simple release):

• It is usually performed in newborns and young infants.
• It can be completed in a short time under local anesthesia.
• Breastfeeding may be possible after the procedure.

2. Frenuloplasty (Advanced surgical correction):

• It is preferred in cases with a thicker or more tightly attached frenulum.
• When necessary, it is performed under general anesthesia.
• Cosmetic sutures may be used to improve tongue mobility.
• It may be supported with speech therapy.

The healing process is usually rapid. After the procedure, improvement in feeding quality in infants and gradual improvement in speech sounds in children may be observed over time.

When Should Tongue-Tie Surgery Be Performed?

• If the baby has feeding difficulties, it can be evaluated early.
• For children with speech sound issues, ages 2–5 may be an appropriate range.
• Surgery can also be performed in adults when deemed necessary.

Planning should be based on the evaluation of an ENT specialist and, when necessary, a speech and language therapist.

Tongue-Tie, Speech, and Ear Health

Restricted tongue movement may affect upper airway development and may be indirectly associated with conditions such as adenoid hypertrophy and middle-ear fluid buildup. For this reason, evaluation by an ENT specialist is important.