What Is a ‘Tethered Tongue’ and How Is It Treated?

Tethered tongue, sometimes called tongue tie, known by the medical term ankyloglossia, occurs when the lingual frenulum, the normal band that connects the underside of the tongue to the floor of the mouth, limits the tongue’s ability to move. This problem can arise when the frenulum is either too short, too thick, attaches to the tip of the tongue or from a combination of these circumstances.

There are no simple answers to what qualifies as a tethered tongue, what problems it causes and whether it should be treated. Adva Buzi, MD, an attending physician with the Division of Otolaryngology (ear/nose/throat) at Children's Hospital of Philadelphia (CHOP), offers facts and insights on the condition.

What problems does a tethered tongue cause?

A tethered tongue can manifest itself differently, and debates still exist as to the implications of having the condition.

• No symptoms: Many people will be asymptomatic and will go their whole lives without knowing they have the condition.
• Difficulty latching on for breastfeeding: The most common symptom of tethered tongue is feeding difficulty, usually when a baby with this anatomical restriction is breastfeeding. Unfortunately, when other factors that can affect breastfeeding are taken into consideration, it is, at times, difficult to ascertain which frenulums are truly symptomatic. A specialist can assess whether other factors are contributing to breastfeeding difficulties.
• Less frequently, older children may experience difficulties with dental hygiene, dental development or speech.

How common is the condition?

The incidence of tethered tongue is difficult to discern because there is no clear definition of the degree of tethering by the lingual frenulum required to constitute ankyloglossia. Some studies have found an incidence of around 10%. Several studies have shown that tethered tongue has been diagnosed more frequently over the past several decades. Many believe that this increase is due to a revived interest in breastfeeding that has occurred over the same time period.

When should an ENT specialist be consulted?

If tethered tongue has been diagnosed and an infant is having latching difficulties, an ENT specialist should be consulted. For speech issues, consultation should be considered but is often followed by a speech evaluation to determine whether the tethered frenulum is what’s affecting articulation.

Should a tethered tongue be treated, and if so, how?

Tethered tongue is treated with a procedure called a frenotomy. A frenotomy can be done in office in an infant (most frequently prior to the age of 3 months). This procedure involves cutting the frenulum down to the base of the tongue muscle. Beyond this age, the procedure is performed under a brief anesthetic. The procedure is similar apart from the use of an absorbable suture to prevent postoperative adherence of the tongue.

Unfortunately, there is not a strong correlation between the degree of tethering of the tongue and the severity of symptoms, making the decision of when to perform a frenotomy a complicated one. The decision to perform a frenotomy should be made on an individual basis after a thorough evaluation of the patient.

Often breastfeeding will improve with time and lactation support. It is difficult to know which infants will benefit from frenotomy, hence, observation in the case of mild symptoms is a valid approach to tethered tongue. Consultation with an experienced physician can help guide in decision-making.