Tongue tie

Ankyloglossia is a congenital anomaly characterized by an abnormally short lingual frenulum. 

In the breastfeeding period, this can lead to difficulties in establishing feeding, manifested by maternal nipple soreness and infant growth retardation*. 

The National Institute for Health and Care Excellence (NICE) has issued guidance for clinicians in the UK, applicable to breastfed babies with ankyloglossia ( This guidance states that:

* A) there are no major safety concerns about sublingual frenectomy and limited evidence suggests that this procedure may improve breastfeeding. This evidence is adequate to support the use of the procedure.

* B) 95% of infants who underwent sublingual frenectomy accompanied by 48 hours of intensive support from a lactation specialist had improved breastfeeding 48 hours after frenectomy, compared to 5% of infants in the control group.

* C) 80% of mothers reported improved breastfeeding 24 hours after the procedure. In another series, 100% of mothers reported improved latching after the procedure, and mothers with nipple pain noted significant improvement immediately after the procedure. In a third case series, 100% of infants were reported to have normal tongue movement at 3 months.

* D) few adverse effects were reported. One case series reported that, after the procedure, 2% of infants had an ulcer under the tongue for more than 48 hours. Two other studies indicated that there were no complications.

Interference with speech development is another reason parents seek consultation. However, early division of the frenulum does not protect against future speech difficulties. Children with ankyloglossia and speech difficulties should first be evaluated by a speech therapist*.

The recommended time to perform frenectomy is at neonatal age. After 12 months of age, it is usually necessary to wait until about 5 years of age and the pronunciation of "R" before performing the procedure under anesthesia.

Sublingual frenectomy

Sublingual frenectomy

Parri Ferrandis FJ - Ankyloglossia in infants: surgical aspects - Cir Pediatr - 2021;34:59-62.

* R Carachi, S Agarwala, TJ BradnockBasic Techniques in Pediatric Surgery.
* JM Hutson, M O’Brien, SW Beasley, WJ Teague, SK King. Jones’ Clinical Paediatric Surgery 7º Ed.