Procedure — Tongue-Tie (Ankyloglossia)
Tongue-Tie Treatment
Tongue-tie, or ankyloglossia, is a tight or short lingual frenulum — the small band of tissue under the tongue — that can limit how far the tongue moves. It's common and usually mild, and most children who have it never need anything done about it. Dr. John Fewins's approach is deliberately conservative: he releases a tongue-tie when there's a real functional reason to, and explains directly to families when there isn't.
Tongue-tie treatment — the short version
- What it does
- Releases a tight or short lingual frenulum that's actually restricting tongue movement.
- Who may benefit
- Infants or children with a functional restriction confirmed on exam — not just a tight-looking band.
- What it won't fix
- A tongue-tie that isn't actually limiting function; most speech delay isn't caused by tongue-tie.
- Typical recovery
- Infants feed immediately after an in-office release; older children have mild soreness for a day or two.
What tongue-tie is
The lingual frenulum is a thin band of tissue connecting the underside of the tongue to the floor of the mouth. In a tongue-tie, that band is short, tight, or attached too far forward, which can limit normal tongue movement.
- Anterior tongue-tie is the classic, visible type: the frenulum attaches near the tip, sometimes giving the tongue a heart-shaped look when the child tries to lift it.
- Posterior tongue-tie sits further back and is more subtle — and it's also the type most prone to over-diagnosis, because a normal frenulum can be mistaken for a restrictive one.
Tongue-tie runs in families and is common: across published studies, a meaningful share of infants are found to have some degree of ankyloglossia. Having a tongue-tie and needing it treated are two very different things. Tongue-tie is sometimes grouped with other oral ties, such as an upper lip tie; Dr. Fewins evaluates the whole picture rather than treating a label, because not every tight-looking band limits function.
Is treatment right for your child?
A tongue-tie only matters when it interferes with function. This is the area where an ENT's judgment earns its keep: diagnoses of ankyloglossia and rates of frenotomy have risen sharply in published research over the past few decades — far more than any real change in how common the condition is. Fewer than half of infants who have a tongue-tie have feeding difficulty from it.
Worth an evaluation
- Infants: difficulty feeding, poor or slow weight gain, or a clicking sound while feeding
- Older children: trouble making certain sounds, messy eating, or difficulty clearing food from the teeth and gums with the tongue
- An open-mouth posture or mouth breathing (many causes; an exam sorts out whether tongue-tie is one)
- A frenulum confirmed on exam to restrict tongue mobility, not just its appearance
Often not the cause
- A tight-looking frenulum with normal tongue mobility and no feeding or functional symptoms
- Speech delay alone, without a confirmed restriction on exam — most speech delay isn't caused by tongue-tie
- A posterior "tie" flagged without a genuine functional limitation on exam
- Feeding difficulty caused by something other than the frenulum
The treatment options range from watchful waiting and simple reassurance, to non-surgical feeding support, to a quick release when there's a clear functional reason — and for many children the right choice is no procedure at all.
How it's evaluated
Diagnosis isn't just a glance under the tongue. Dr. Fewins performs a focused physical exam and assesses tongue mobility — the tongue's range of motion, how far it lifts and extends, and whether the frenulum limits normal movement. Function matters more than appearance: a frenulum can look tight and work perfectly well, or look subtle and truly restrict. This is also where a posterior tongue-tie is either confirmed or set aside, since it's the type most often over-called. That functional assessment is what separates a tongue-tie that needs treating from one that doesn't.
How a release is done
The right approach depends almost entirely on the child's age.
Infants
A tongue-tie release — a frenotomy — is a simple in-office procedure. The lingual frenulum has very little blood supply, so the band is easily snipped or incised with almost no bleeding, no anesthesia is needed, and the whole thing takes only a few minutes. Babies can feed right afterward.
Older children
By the time a child is older, the frenulum is thicker and children are understandably anxious about a procedure in the mouth. An older child's release — a frenuloplasty, which repairs the thicker tissue — is usually done as a brief procedure under general anesthesia, and it sometimes needs a few dissolvable sutures. Done this way it's safe, controlled, and comfortable for the child.
In both cases the aim is the same: release the restriction cleanly and let the tissue heal.
Laser versus scissors
Laser tongue-tie release is heavily marketed, often with claims that it seals tissue as it cuts, reduces bleeding, and lowers infection risk. Dr. Fewins doesn't use a laser for tongue-tie, and his reasoning is evidence-based: there's no good evidence that a laser produces better results than a simple release with surgical scissors. A laser works by burning tissue, which destroys the surrounding tissue the body uses to heal, and can cut deeper than intended; laser release has also been associated with more oral aversion in infants than a scissors or scalpel release. A laser adds cost and risk without a proven benefit — for a procedure this small, the simplest safe method is the best one.
Recovery & reattachment
Aftercare is minimal. Infants can feed immediately, with no restrictions to speak of. Older children who had a release under anesthesia recover quickly, usually with only mild soreness for a day or two.
A released tongue-tie can occasionally reattach, though it's uncommon. Some providers respond by prescribing intensive daily stretching or "active wound management" routines to prevent it; the evidence for those aggressive protocols is limited and debated, and Dr. Fewins doesn't routinely put families through them. He'll give you simple, sensible aftercare and tell you what to watch for, without turning recovery into a project.
Alternatives when a release isn't indicated: watchful waiting, non-surgical feeding support for infants, or treating another underlying cause — and a speech-language evaluation only when a child's speech genuinely warrants one.
Tongue-tie and speech
Tongue-tie is frequently blamed for speech problems, and that connection is weaker than most people assume. The evidence linking ankyloglossia to speech difficulty isn't clear-cut: most speech delays are multifactorial, some children with a significant restriction speak perfectly well, and some children with real speech delays have no tongue-tie at all. When a tongue-tie does affect speech, it usually shows up on certain sounds that need the tongue tip to lift. Even so, neither infants nor older children typically need routine speech therapy after a release in Dr. Fewins's experience. A careful evaluation before any procedure, and a speech-language assessment only when a child's speech warrants it, avoids both under-treatment and unnecessary treatment.
Adults with tongue-tie
Tongue-tie is occasionally identified in adults. It's far less common as a reason for treatment, and each case is evaluated individually — a release in an adult can often be done under local anesthetic, technique differs from a child's, and any concern about the airway or voice is assessed on its own merits. If you're an adult wondering whether a tongue-tie is causing a real problem, an evaluation will tell you.
Frequently asked questions
Will my child's tongue-tie grow back after it is released?
Reattachment can happen but is uncommon. Dr. Fewins does not routinely prescribe the intensive stretching regimens some providers use to prevent it, because the evidence for those protocols is limited. He will give you simple aftercare and tell you what to watch for.
Will my child need speech therapy after a release?
Usually not. Tongue-tie is often over-blamed for speech problems, and most children do not need routine speech therapy after a release. If a child has a genuine speech concern, that is evaluated on its own.
Do you use a laser?
No. There is no good evidence a laser works better than a simple scissors release, and a laser burns surrounding tissue the body uses to heal and can cut too deeply. Dr. Fewins uses a clean scissors release and lets the tissue heal naturally.
Does the infant procedure hurt, and does it need anesthesia?
No anesthesia is needed for infants. The frenulum has very little blood supply, so the release is quick, bleeding is minimal, and babies can feed right afterward.
Does my baby even need this?
Often, no. Many tongue-ties never cause a problem, and fewer than half of infants with one have feeding difficulty from it. Dr. Fewins evaluates whether the tongue-tie is restricting function before recommending anything.
Is tongue-tie release covered by insurance?
Coverage depends on the medical indication and your insurance plan. Our office can help verify benefits and any authorization requirements.