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 is common and usually mild. Most children who have it never need anything done about it.
When a tongue-tie genuinely restricts function, a simple release can help. But this is an area where more surgery is not better surgery. Dr. John L. Fewins is a board-certified ENT who treats tongue-tie at Expert ENT Care in Fort Worth and Cleburne, and his approach is deliberately conservative: he releases a tongue-tie when there is a real functional reason to, and he tells families plainly when there is not.
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. It is 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 large studies, roughly 8 percent of infants are found to have some degree of ankyloglossia. The key point is that 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 actually limits function.
Signs That Sometimes Point to Tongue-Tie
A tongue-tie only matters when it interferes with function. Signs that occasionally warrant an evaluation include:
- In infants: difficulty feeding, poor or slow weight gain, or a clicking sound during feeding
- In older children: trouble making certain sounds, messy eating, or difficulty clearing food from the teeth and gums with the tongue (an oral hygiene concern)
- At any age: an open-mouth posture or mouth breathing, which has many possible causes a proper exam can sort out
These signs have many possible causes, and a tongue-tie is only sometimes the reason. That is exactly why an evaluation matters more than a snapshot: the goal is to find out whether the frenulum is actually the problem before treating it.
How a Tongue-Tie Is Evaluated
Diagnosis is not 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 genuinely limits normal tongue 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 is the type most often over-called. That functional assessment is what separates a tongue-tie that needs treating from one that does not.
When Treatment Is – and Isn’t – Needed
This is the most important section, and it is where an ENT’s judgment earns its keep. Tongue-tie is currently over-diagnosed and over-treated. According to the American Academy of Pediatrics, diagnoses of ankyloglossia and rates of frenotomy rose roughly ten-fold between 1997 and 2012, and then doubled again over the next few years – a jump far larger than any true change in how common the condition is. The Academy urges that non-surgical options be considered first, and notes that fewer than half of infants who have a tongue-tie actually have feeding difficulty from it.
Dr. Fewins practices accordingly. He evaluates how the tongue functions, not just how the frenulum looks, and he does not release a tongue-tie that is not causing a problem. The treatment options genuinely range from watchful waiting and simple reassurance, to non-surgical support, to a quick release when there is a clear functional reason – and for many children the right choice is no procedure at all. When there is a real indication, a release is a small, effective surgical treatment. When there is not, the honest recommendation is to leave it alone.
How Dr. Fewins Performs a Tongue-Tie Release
The right approach depends almost entirely on the child’s age.
Infants. In babies, 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, two things change: the frenulum is thicker, and children are understandably anxious about a procedure in the mouth. For that reason, 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 is 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: Why Dr. Fewins Uses Scissors
Laser tongue-tie release is heavily marketed, often with claims that it seals the tissue as it cuts, reduces bleeding, and lowers infection risk. Those are the arguments you will hear for it.
Dr. Fewins does not use a laser for tongue-tie, and his reasoning is evidence-based. There is 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 that the body actually uses to heal, and it can cut deeper than intended. In the literature, laser release has also been associated with more oral aversion in infants than a scissors or scalpel release. Taken together, a laser adds cost and risk without a proven benefit, and there are likely more complications from it than from a clean scissors release that is allowed to heal naturally. For a procedure this small, the simplest safe method is the best one.
Aftercare and Reattachment
Aftercare is minimal. Infants can feed immediately, and there are 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 word on reattachment, because families hear a lot about it. A released tongue-tie can occasionally reattach, though it is uncommon. Some providers respond to this 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 does not routinely put families through them. He will give you simple, sensible aftercare and tell you what to watch for, without turning recovery into a project.
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 is not 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, and some children develop compensatory habits to work around it. Even so, in Dr. Fewins’ experience, neither infants nor older children typically need routine speech therapy after a release. A careful evaluation before any procedure, and a speech-language assessment only when a child’s speech genuinely warrants it, is what avoids both under-treatment and unnecessary treatment.
Adults With Tongue-Tie
Tongue-tie is occasionally identified in adults. It is 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 are an adult wondering whether a tongue-tie is causing a real problem, an evaluation will tell you.
Why Choose Expert ENT Care for Tongue-Tie
- Board-certified ENT with deep pediatric experience. Dr. John L. Fewins has cared for children’s ear, nose, and throat conditions for decades.
- Conservative, honest judgment. He releases a tongue-tie when it is genuinely indicated and tells you when it is not – no upselling a procedure your child does not need.
- The right setting for the child. A quick in-office release for infants; a safe, comfortable procedure under general anesthesia for older children.
- Two convenient locations. Care and follow-up at our Fort Worth and Cleburne offices.
Good questions to ask any provider: Is this tongue-tie actually causing a functional problem? What happens if we do nothing? Why this method, and what is the evidence for it?
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 actually restricting function before recommending anything.
Is tongue-tie release covered by insurance?
When there is a genuine medical indication, it is almost always covered by insurance. Our office can help verify your benefits.
Next Steps: Evaluation and Booking
If you think a tongue-tie might be affecting your child, the first step is a straightforward evaluation – not a procedure. For infants, it helps to bring a short note of feeding and weight history. Call to schedule at our Fort Worth or Cleburne office.
Call (817) 335-0368 to schedule an evaluation.
Medically reviewed by John L. Fewins, MD, FACS.
