When is a tongue tie release recommended?

When Tongue Tie Should Be Released

Tongue tie (ankyloglossia) should be released when it causes documented breastfeeding difficulties with objective evidence of impaired latch, maternal nipple pain, or inadequate infant weight gain, as frenotomy in these cases yields objective improvements in milk production, breastfeeding characteristics, and reductions in maternal pain. 1

Primary Indication: Breastfeeding Problems

• Release is indicated for infants with tongue tie who have breastfeeding difficulties, as division (frenotomy) produces objective improvements in milk production, breastfeeding scoring measures, weight gain, and maternal pain reduction 1
• For the majority of mothers, frenotomy enhances maintenance of breastfeeding 1
• The procedure is safe with minimal complications, most commonly minor bleeding 1

Assessment Before Release

Anterior Tongue Tie

• Anterior tongue-tie is accepted in most clinical practices as a potential risk for breastfeeding difficulty, and good evidence exists that division leads to improved breastfeeding outcomes 2
• This represents the clearest indication for intervention 2

Posterior Tongue Tie

• Posterior tongue ties may play a role in effective breastfeeding 3
• In some breastfeeding studies, releasing the posterior tie has improved certain aspects of tongue movement 3
• Posterior ties are being studied more intensively to provide sound, evidence-based recommendations on diagnosis and treatment 2

Speech-Related Indications

• There is currently insufficient evidence to support prophylactic frenotomy for speech development, and this practice is not condoned based on current research 1
• Limited reports suggest prophylactic frenotomy may promote subsequent speech development, but evidence is insufficient and further quality research is warranted 1
• There is little evidence for or against posterior tongue ties contributing to speech problems 3

When Speech Is Already Affected

• If a patient presents with established speech clarity problems attributed to tongue tie (such as restricted tongue protrusion affecting articulation), release may be considered 4
• A 24-year-old with class II moderate lingual tie and speech difficulties showed improvement after lingual frenectomy 4

Solid Feeding Considerations

• There is little evidence for or against posterior tongue ties contributing to solid feeding problems 3
• This remains an area requiring further research before definitive recommendations can be made 3

Post-Release Management

• Orofacial myofunctional therapy (OMT) plays an important role both before and after surgical release to establish proper tongue posture and reduce probability of tissue reattachment 5
• OMT exercises help maintain proper tongue posture, improve speech, swallowing, and prevent recurrence of difficulties 5
• Recurrence requiring redivision occurs in 0.003-13% of cases, appearing more common with posterior than anterior ties 1

Common Pitfalls to Avoid

• Do not perform prophylactic release solely for potential future speech problems without current functional impairment 1
• Ensure objective documentation of breastfeeding difficulties (not just subjective maternal concern) before proceeding 1
• Do not neglect post-operative therapy, as exercises are crucial for preventing reattachment and optimizing functional outcomes 5