The small fold of tissue underneath your tongue, connecting it to the floor of your mouth, is called the lingual frenulum (or lingual frenum). This thin structure is easily visible when the tongue is lifted. While its presence is normal, variations in its length and elasticity can affect the tongue’s ability to move freely. The lingual frenulum plays an important role in various oral functions.
Anatomy and Function of the Lingual Frenulum
The lingual frenulum is a band of connective tissue composed primarily of a mucous membrane fold. This membrane contains an epithelium layer and a submucosa layer, which is made up of fibroblasts and collagen bundles. Its primary purpose is to anchor the tongue and stabilize its position within the mouth, preventing excessive forward or downward movement.
This stabilization is crucial for the complex mechanics of speech and swallowing. The tongue requires a broad range of motion to articulate specific sounds, particularly those involving the tip. In infants, a properly functioning frenulum is necessary for the tongue to cup the nipple and create the suction required for effective breastfeeding. Unrestricted movement is typical for proper oral function.
Understanding Ankyloglossia
When the lingual frenulum is unusually short, tight, or thick, it restricts the tongue’s mobility. This condition is known as ankyloglossia, or “tongue tie.” This congenital condition occurs when the frenulum fails to separate completely before birth, tethering the tongue’s tip closer to the floor of the mouth. Ankyloglossia is relatively common, affecting approximately 4 to 10 percent of newborns, and is slightly more prevalent in males.
In infants, the most immediate symptoms relate to feeding difficulties. A baby with ankyloglossia may struggle to achieve a deep latch during breastfeeding, often resulting in a clicking sound or frequently losing suction. This ineffective feeding can lead to poor weight gain in the infant and significant nipple pain for the nursing parent.
As a child grows, a short frenulum can affect speech articulation, particularly with sounds like ‘l,’ ‘r,’ ‘t,’ ‘d,’ and ‘th’. The restricted movement can also make it difficult to perform simple tasks, such as licking an ice cream cone or clearing food debris from the teeth. Over time, the constant tension on the tissue can contribute to the formation of a gap between the lower front teeth.
Addressing a Short Frenulum
Treatment for ankyloglossia is typically recommended only when the condition causes functional problems, such as feeding difficulties or speech impairment. The procedure used to correct a restrictive frenulum is generally safe and minimally invasive.
For infants, the most common intervention is a frenotomy, a simple surgical cut performed with sterile scissors or a laser to release the frenulum. This procedure is very quick and often requires no anesthesia because the frenulum has few nerve endings or blood vessels. Bleeding is usually limited, and the infant can often breastfeed immediately afterward.
When the tissue is unusually thick or the patient is older, a more involved procedure called a frenuloplasty may be required. Frenuloplasty is a more extensive surgical repair, sometimes performed under local or general anesthesia, where the frenulum is repositioned or released and closed with dissolvable sutures. While recovery from a simple frenotomy is fast, a frenuloplasty requires a slightly longer healing period. Both procedures aim to increase the tongue’s range of motion, often followed by exercises to maximize function.