Tongue Ties: Lingual Frenectomy vs Lingual Frenuloplasty

Teenage girl covering her mouth with hands.

A tongue tie is a congenital condition that restricts the movement of the tongue. It is estimated that almost 5% of children are born with a tongue tie that can impact their tongue movement for breastfeeding and speech. There are dental procedures that can be used to free a tongue tie: the lingual frenotomy, lingual frenectomy and the lingual frenuloplasty. If you have an older child with a tongue tie, which is a better procedure for treatment, a lingual frenectomy or frenuloplasty? Here is what you need to know about these two procedures.

What Is a Tongue Tie?

Ankyloglossia, more commonly known as “tied tongue or a tongue tie,” is an abnormality of the lingual frenulum. The lingual frenulum, the band of tissue that connects the tongue to the floor of the mouth, is abnormally short, thick and tight in individuals with ankyloglossia. This affects the movement of the tongue and can cause eating, speech, tooth development, oral health and psycho-social problems. Ankyloglossia is a condition some people are born with, whether due to hereditary or environmental factors.

A tongue tie can cause problems early on with some infants, but not all tongue ties are noticeable right away. A severe tongue tie may restrict the tongue enough to make it difficult for an infant to breastfeed. The infant may not be able to latch correctly to the breast, but may be able to feed better when they are bottle-fed. Infants may fuss when feeding or tend to “chew” versus suck on the nipple, which can result in painful feeding for the mother. Beyond breastfeeding, other symptoms that are caused by ankyloglossia:

  • Tongue is heart- or V-shaped when stuck out
  • Difficulty chewing foods
  • Infants with low weights or slow growth
  • Difficulty licking (ice cream, lollipops) or sticking out tongue
  • Speech issues with certain sounds – enunciation of “t, s, th, z, d, l, r and n”
  • Dribbling or drooling
  • Dental problems – cavities, gapped front teeth or gingivitis
  • Choking or gagging on foods

In infants with a severe tongue tie that is restricting feeding, a frenotomy may be performed in infancy. Some children do overcome mild ankyloglossia as they become older and do not require treatment. When there are persistent problems into childhood or adulthood caused by a tongue tie, treatment may be required to fix the issue. Both doctors and dentists may offer procedures to release a tongue tie to allow improved movement of the tongue to correct speech impediments, eating difficulties and dental problems.

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What Is a Tongue Tie Treatment?

A lingual frenotomy is a quick snip of the frenulum in infants with a tongue tie. Lingual frenectomy and frenuloplasty are both dental procedures used to correct ankyloglossia in children or adults with thicker frenulum that cannot be simply “snipped.” These tongue tie treatments can both release the lingual frenulum to allow for more normal movement of the tongue. What is the difference between the two procedures, and which is the best option for tongue tie treatment? Here are the basics on lingual frenectomy versus lingual frenuloplasty.

Lingual Frenectomy
Lingual frenectomy is a surgical procedure that involves completely removing the lingual frenulum at its attachment to the bone. It is performed by an oral surgeon with the help of local anesthesia. The procedure takes 10 to 15 minutes to complete, and the patient is left with a short row of stitches on the underside of the tongue. Serious side-effects are not typically seen with lingual frenectomy; however, potential complications include bleeding, infection and in some cases, temporary or permanent nerve damage.
Lingual Frenuloplasty
Lingual frenuloplasty differs from lingual frenectomy in that the frenulum is not completely removed, but only altered. The goal of lingual frenuloplasty is to snip the lingual frenulum just enough to loosen it and increase the mobility of the tongue. A lingual frenuloplasty can be used to reposition the frenulum and move the attachment point. In terms of procedure length and post-operative expectations, lingual frenuloplasty is very similar to lingual frenectomy – if the frenuloplasty is not successful, a frenectomy may be needed.

Lingual frenectomy and frenuloplasty may be performed using a scalpel (surgical knife) or a soft tissue laser. Laser dental surgery has several advantages compared to dental surgery done with a scalpel. Ankyloglossia treated with a laser does not require stitches, and results in less pain and bleeding. Many dentists now offer both surgical and laser lingual frenectomy and lingual frenuloplasty.
A child licking ice-cream
In many infants, a frenotomy can be performed with surgical scissors as a quick tongue tie release. For older children and adults, a dental procedure can be used to release a tongue tie for improved speech and oral health. Both the lingual frenectomy and lingual frenuloplasty can be useful in correcting an abnormally short frenulum, one removing the frenulum (frenectomy) and one repositioning the frenulum (frenuloplasty). To learn more about lingual frenectomy versus frenuloplasty, talk to your local dentist.