Treatments: Lip Tie and Tongue Tie (Ankyloglossia)

This page describes when treatment of tongue tie and lip tie helps, the procedures used, and what to expect afterward.

This page describes the treatment choices for tongue tie and lip tie in babies, children and adults: what the options are, when treatment actually helps, and what to expect. The condition itself is described on the lip tie and tongue tie conditions page.

The Most Important Idea: Treat the Problem, Not the Picture

A tongue tie (a tight band of tissue under the tongue) or lip tie (a tight band behind the upper lip) is a normal variation of mouth anatomy. Many people have one and never have any trouble because of it. Current expert consensus is that treatment is considered only when there is a real, documented problem with function, such as feeding difficulty, that has not improved with supportive care and that can be clearly linked to restricted tongue movement.

The appearance of the tissue alone is not a reason to operate. Procedures done only to prevent possible future problems, or for vague symptoms, are generally not supported by current evidence.

Treatment Options for Infants

Observation and watchful waiting. If a baby is feeding well and gaining weight, no treatment is needed, even if a tie is visible. Feeding difficulty and maternal nipple pain linked to a tie can also improve on their own over time without any surgery.

Lactation and feeding support (first step). Because painful or ineffective feeding usually has several contributing causes, a full feeding assessment comes before any procedure. A lactation consultant or feeding specialist can help with latch, positioning, pacing of feeds and other techniques. Many feeding problems resolve at this stage. Other causes are also checked, such as nasal or airway issues, reflux or jaw differences in the baby, and nipple or milk-supply factors in the mother.

Frenotomy (the main procedure for babies). This is a simple, quick release of the tight band. The tongue is lifted, the band is divided, and brief pressure stops any minor bleeding. The baby can usually feed right afterward. It is typically done in the office without stitches and without general anesthesia. For comfort, a small amount of oral sugar (sucrose) solution or breastfeeding can be used; numbing gels are generally avoided in infants, and benzocaine gels in particular are not used in children under 2.

When frenotomy is reasonable in a baby. It can be offered after other causes of feeding trouble have been looked at and addressed, when there is significant, well-documented breastfeeding difficulty (such as poor latch, very painful nipples or poor weight gain) that persists despite good feeding support and is clearly tied to restricted tongue movement. Its best-supported benefit is reducing a mother's nipple pain and improving her sense that feeding is working.

What is not supported in babies. Releasing a tie to prevent future speech problems or sleep apnea is not evidence based. "Lip tie" and cheek (buccal) bands are normal structures that do not need surgery to improve breastfeeding. So-called "posterior tongue tie" is a poorly defined term and is not by itself a good reason for surgery.

Treatment Options for Older Children and Adults

Observation and non-surgical care. Many children with a tie have normal, age-appropriate speech or use effective workarounds. The link between tongue tie and speech problems is weak, and surgery for speech concerns alone, without a clear physical restriction, is not well supported. Non-surgical options include watchful waiting and evaluation by a speech-language pathologist.

Speech-language therapy. A speech therapist can assess articulation and oral-motor function and guide therapy. In selected cases where a procedure is done, speech therapy afterward may help retrain tongue movement patterns.

Myofunctional therapy. This involves exercises and massage to improve tongue strength, mobility and coordination. Evidence is limited and of modest quality. It appears most useful as a complement to a procedure rather than a replacement for it; combining the two tends to give better results than either alone in studies to date. In infants, a gentle oral-motor program has shown some benefit for feeding in early research, but this is still an emerging area.

Frenotomy, frenectomy and frenuloplasty (the terms differ). These words are often mixed up but mean different things:

• Frenotomy: a simple cut to release the band (the usual procedure in infants).

• Frenectomy: removal of the band of tissue.

• Frenuloplasty: releasing the band and rearranging or lengthening the tissue (for example, a Z-plasty), sometimes with stitches.

Frenuloplasty is more often chosen for patients over about one year of age, for more significant restriction or scarring, or when the tongue needs more length. In older children and adults, these more involved procedures are frequently done under general anesthesia, often in an operating room or specialty setting. Preparation is described in the frenulectomy surgery packet.

Scissors Versus Laser: What the Evidence Shows

For infants, a simple scissors (cold-steel) release is the best-studied, most widely used technique. It needs little equipment, can be done in the office and has a very low rate of serious complications.

Laser and electrosurgery devices have become popular in some practices. Their possible advantages include less bleeding during the procedure and, in some studies of older patients having frenectomy, less post-procedure pain. However, there is no good evidence that laser produces better feeding or speech outcomes than scissors. Expert consensus is that no single technique has been proven superior. Laser also requires special equipment, training and eye protection, and may cost more. Some reports in infants describe more feeding refusal or mouth aversion after laser or electrosurgery than after scissors. For most babies, a brief scissors release by an experienced clinician offers the best balance of simplicity, safety and proven benefit.

Post-Procedure Care

• Feeding or comfort right away. Babies can usually feed immediately, which also comforts them.

• Minor bleeding and soreness. A small amount of bleeding is normal and usually stops with gentle pressure. Mild discomfort is common and short-lived.

• Stretching exercises are not part of routine care. Routinely opening the wound with stretching massage to "prevent reattachment" is not supported by evidence and may cause mouth aversion (a baby becoming upset or refusing to have the mouth touched or to feed). No specific post-procedure care routine has been proven to improve results.

• Follow-up. A scheduled check helps confirm that feeding or tongue movement has improved and helps catch any problem such as bleeding, infection, re-attachment or feeding aversion.

• Older children and adults who have a frenuloplasty with stitches may have specific wound-care and activity instructions from their surgeon, and may be referred for speech or myofunctional therapy. See frenulectomy recovery.

Expected Results

• Feeding. In carefully selected, symptomatic breastfeeding pairs, release can reduce the mother's nipple pain and improve her sense that feeding is working, sometimes with better latch scores. Improvement is not guaranteed; the procedure does not always relieve pain or feeding difficulty, and this is important to understand before agreeing to it.

• Speech. Evidence that release improves speech is weak. Some families report improvement in selected cases, but routine surgery for speech alone is not supported.

• Resolution without surgery. Feeding difficulty and nipple pain linked to a tie can also get better without any procedure.

• Tooth gap. No definitive link has been established between the upper lip frenulum and a gap between the upper front teeth. Such gaps often close on their own as the permanent canine teeth come in, release has not been shown to prevent or treat a gap in the permanent teeth, and scarring from an early procedure could make a gap more likely later.

Risks and Things Discussed Beforehand

Frenotomy is generally safe and well tolerated, and serious complications are rare. Possible risks include:

• Bleeding

• Infection

• Pain or temporary feeding or mouth aversion

• Scarring or re-attachment of the tissue

• Rare but more serious events: significant bleeding, airway problems, or injury to nearby salivary (spit gland) structures

• The possibility that feeding or symptoms do not improve

Some patients may be less suited to an in-office infant procedure, including those with a small or set-back jaw, low muscle tone or neuromuscular conditions, or a bleeding or clotting disorder. These situations are discussed with the clinician.

Before any procedure, families can expect to give informed consent and to review the alternatives (including waiting, more lactation support or speech therapy), the risks and benefits, pain-control options, and the fact that improvement is not certain.

Key Takeaways

• A visible tie that causes no functional problem does not need treatment.

• Feeding support and a full assessment come first; many problems resolve without surgery.

• When a procedure is warranted, a simple scissors frenotomy is the best-supported option in infants.

• No technique, including laser, is proven better than another.

• Routine post-procedure stretching is not part of evidence-based care.

• Surgery to prevent future speech or sleep problems, or for vague symptoms, is not supported by current evidence.