Ankyloglossia, commonly known as a tongue tie, is a condition where a short, thick, or tight band of tissue, called the lingual frenulum, restricts the tongue’s range of motion. This restriction can interfere with an infant’s ability to latch effectively during feeding, and in older children and adults, it may affect speech, oral hygiene, and swallowing. The minor surgical procedure to release this restrictive tissue is known as a frenotomy or frenectomy. A variety of trained medical and dental professionals are qualified to perform this procedure, which is typically quick and often done in an office setting.
Who First Identifies a Tongue Tie?
The initial suspicion of a tongue tie often arises from professionals focused on infant feeding and early development. Pediatricians and midwives frequently conduct initial assessments of newborns and may notice the anatomical restriction. They monitor for symptoms like difficulty latching, poor milk transfer, or slow weight gain, which can point toward a functional issue.
International Board Certified Lactation Consultants (IBCLC) are often the first to perform a detailed functional assessment due to their expertise in breastfeeding dynamics. They evaluate how the baby uses their tongue during a feeding session, looking for functional limitations in extension, lift, and side-to-side movement. Although IBCLCs do not perform surgery, they play a primary role in identifying the problem and initiating the necessary referral to a specialist for diagnosis and treatment.
Medical Specialists Who Perform the Surgery
Medical doctors (MDs or DOs) with specialized surgical training perform frenotomies. Otolaryngologists (ENT specialists) commonly perform this procedure, especially in cases where other upper airway or complex feeding issues are present. These specialists may use traditional surgical tools like scissors or a scalpel to make a precise cut.
Oral and Maxillofacial Surgeons (OMS) are another group qualified to perform the release, sometimes using more extensive procedures like a frenuloplasty for thicker or more complex tissue restrictions. Specialized general surgeons or pediatricians who have received specific training may also perform a frenotomy, particularly in newborns. The traditional technique can sometimes be conservative to avoid excessive bleeding, which may lead to undercorrection in some instances.
Dental Specialists and Advanced Techniques
Dental professionals specializing in oral structures play a significant role in tongue tie release, often utilizing advanced technology. Pediatric Dentists are highly trained in the oral health and development of children and frequently perform frenectomies. General Dentists who have completed specialized training also offer this service.
Many dental specialists use a soft-tissue laser, such as a CO2 laser, to perform the procedure, often termed a laser frenectomy. This technique vaporizes the restrictive tissue and simultaneously cauterizes blood vessels, resulting in minimal bleeding and reduced need for sutures. The precision provided by the laser allows the specialist to ensure a more complete release of the restrictive fibers, minimizing the risk of reattaching during the healing process. Patients often experience less post-operative discomfort and enjoy a faster recovery time.
Post-Procedure Support Team
The success of a tongue tie release is highly dependent on the team of non-surgical professionals who provide post-operative support and rehabilitation. Lactation Consultants (IBCLC) are crucial after the procedure, helping the mother and baby adjust to the newly gained mobility of the tongue. They guide the pair in re-establishing an effective latch and monitor for proper milk transfer, as the baby needs to learn how to use the tongue in a new, unrestricted way.
Physical Therapists (PT), Occupational Therapists (OT), and Speech-Language Pathologists (SLP) may also be involved. These therapists provide post-frenectomy exercises, sometimes called stretches, to ensure the wound heals without contracting and restricting movement again. SLPs, in particular, may assist older children with improving any speech sound production issues related to the previous lack of tongue mobility.