We have recently had an unusually high number of people in our practice asking questions about tongue-release surgery. This article aims to provide information so that patients and parents can better discuss this topic with their doctors.

(NOTE: This is the second of two articles on tongue ties and tongue release surgery. Click HERE for the first half)

What is tongue-release surgery (frenotomy)?
Tongue-release surgery, formally known as a frenotomy, involves cutting the lingual frenulum to increase the tongue's mobility. Variations of this procedure include the frenectomy and the frenuloplasty. This procedure can be performed with a scapel or soft-tissue laser.

What are the claimed benefits of tongue-release surgery?
While most online information about these topics is specific to breastfeeding in infants, other healthcare providers, primarily dentists, also advertise the benefits of tongue-release surgery for children, adolescents, and adults. Their claims include improved breathing, relief of TMJ pain, better orthodontic results, more enjoyable eating, clearer speech, improved oral health, and improved overall quality of life.

What is the difference between a testimonial and evidence-based research?
Although testimonials from patients who have had these surgeries exist, most are found on the websites of the doctors who perform them. There are no checks and balances or guidelines for testimonials. Evidence-based research, however, requires appropriate sample sizes, random selection, control groups, and peer review to ensure that the treatment being evaluated is responsible for the results achieved. Such research reduces the likelihood that patients receive unnecessary or inappropriate care.

Who are the experts when it comes to tongue-release surgery?
As of 2023, perhaps the most authoritative article on tongue-release surgery is the Clinical Consensus Statement: Ankyloglossia in Children, published by the American Association of Otolaryngology in 2020. Otolaryngologists (ENTs) are the experts in this field, and this paper represents their current "standard of care" for diagnosing and treating these problems.

Can tongue-release surgery improve breastfeeding?
The short answer is yes. Ankyloglossia can cause pain and poor latch, and if indicated, a frenotomy can improve these conditions. Because a simple oral exam may identify a tongue tie, however, it is often quickly targeted as the primary causation. These symptoms can also be present with other etiologies; therefore, all other possible causes should be ruled out before surgery. According to lactation specialists, 70% to 90% of breastfeeding problems are merely due to suboptimal positioning at the breast. Additionally, even when some degree of ankyloglossia is present, many infants and mothers breastfeed successfully without surgery. Lactation consultants are experts in breastfeeding and should be consulted before subjecting an infant to tongue-release surgery.

Can tongue-release surgery prevent or cure sleep apnea?
Of all the research papers that met the criteria for inclusion in the Consensus, only one study reported an association between ankyloglossia and obstructive sleep apnea (OSA). The consensus authors noted that this study had a small sample size and lacked a control group, two essential features of high-quality research. In fact, several other studies suggest that since the lingual frenulum tethers the tongue forward (preventing its collapse towards the back of the throat), frenotomies could actually lead to worsening OSA. To date, there is no evidence that tongue-release surgery can prevent or cure obstructive sleep apnea. Patients with suspected breathing disorders should be evaluated by an ENT, pulmonologist, or physician trained in sleep medicine before consenting to surgery.

Can tongue-release surgery improve speech?
A few studies suggested an association between ankyloglossia and speech problems, but these were also deemed to be of questionable quality. The position of the ENTs who produced the Consensus paper was that tongue ties do not typically affect speech. Because there is conflicting data regarding frenotomies' efficacy in treating speech problems, parents should consult a speech pathologist before submitting their children to surgery.

Can ankyloglossia affect the alignment of the teeth?
An attachment of the lingual frenulum that extends between the lower incisors can create a space. While there are varying theories on the timing of a frenectomy, the most commonly accepted is to first close the space orthodontically and then remove the excessive interdental tissue afterward. This approach allows the gum tissue to heal around the teeth in their new position and prevents scar tissue formation in the area before the space is closed.

Can tongue-release surgery prevent the need for braces or extractions?
Although some theorize that tongue-release surgery elevates the tongue, increases the size of the palate and dental arches, and reduces dental crowding, no studies to date support these theories. Subjecting children to tongue-release surgery to prevent or correct orthodontic problems is not currently supported by the scientific literature.

Does untreated ankyloglossia lead to cavities and gum disease?
Some dentists have suggested that tongue ties may contribute to other dental issues, including cavities and gum disease, because the reduced mobility prevents the tongue from keeping the teeth clean. The scientific literature does not support the theory that tongue-release surgery improves oral health.

Does tongue-release surgery have any effect on TMJ pain or quality of eating?
Claims that frenotomies relieve TMJ pain or provide more enjoyable eating are "testimonials" and are not supported by the scientific literature.

Are frenotomies ever justified for cosmetic or other social reasons?
Attachment of the lingual frenulum close to the tip of the tongue could create social issues for patients if their tongues look different than their peers or prevents them from performing typical actions like their friends. The inability to stick out one's tongue or lick a sucker could lead to embarrassment in social settings. A simple frenotomy could remedy this problem.

What are the possible complications of tongue-release surgery?
Lingual frenotomies are generally safe and well-tolerated procedures. As with any medical or dental procedure, however, there are possible complications, including bleeding, infection, airway obstruction, injury to the salivary structures, nerve damage, and scarring. Patients and parents must weigh the potential risks of these procedures with the intended benefits before giving consent.

Our advice regarding tongue-release surgery
Our advice to patients who question the need for frenotomies is: 1) Tongue-release surgeries can be beneficial when needed, 2) Parents should seek the advice of lactation consultants, speech pathologists, and sleep medicine physicians before subjecting their children to tongue-release surgery for these problems, 3) Surgery may also be justified in patients where limited tongue mobility causes social issues, 4) There is no evidence that tongue-release surgery can prevent or cure obstructive sleep apnea or orthodontic problems, and 5) "If it ain't broke, don't fix it!" We would subject our family members to tongue-release surgery only if they were experiencing problems specifically related to limited tongue mobility.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist in the private practice of orthodontics in Rio Rancho and Albuquerque, New Mexico. He was trained at BYU, Washington University in St. Louis, and the University of Iowa. Dr. Jorgensen's 30+ years of specialty practice and 10,000+ finished cases qualify him as an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in New Mexico. He cannot diagnose cases described in comments nor select treatment plans for readers. The opinions expressed here are protected by copyright laws and can only be used with the author's written permission.