Introduction

Our tongue is a highly vascular, pink, muscular, fleshy organ that plays a vital role in eating, swallowing, tasting and speaking. If you look in the mirror and touch your tongue to the roof of your mouth, you will notice that a loose, flexible tissue band (called the lingual frenulum) attaches it to the bottom. The lingual frenulum helps us move our tongue while eating, speaking and gargling. A ‘Tongue-tie’ or ‘Ankyloglossia’ (Anklyo= stiff or fixed and glossia= tongue) is where the frenulum is shorter, tighter and thicker and causes limited movement. Tongue-tie is a condition that is present from birth and can affect its functionality. The severity depends on how short the frenulum is.

Some clinicians prefer to take a wait-and-watch approach as it may correct itself. Others prefer surgical correction as soon as it is diagnosed to improve the baby’s feeding and overall development¹. Post-operative care is important to promote healing and reduce the recovery time after surgery. This article will explain how to take the proper care to help speed up recovery after tongue-tie surgery.

What is Tongue-tie?

Definition

Tongue-tie or Ankyloglossia is a condition that limits or restricts tongue movement due to a short and thick band of tissue called the lingual frenulum that connects the tongue to the bottom of the mouth.²

Normally, before birth, the lingual frenulum separates or moves back. But if the frenulum fails to separate from the tip of the tongue, it leads to restricted mobility of the tongue. 

Causes

This condition is mainly caused by genetics and may run in families. 

It can also be due to abnormal fetal development or abnormal positioning. 

Prevalence

Tongue-tie affects around 5% of all newborns. It is more often seen in assigned male at birth (AMAB) than assigned female at birth (AFAB).

Signs and symptoms

Common signs and symptoms for different age groups are:

Tongue-tie surgery

Tongue-tie surgery (called ‘Frenotomy/ Frenectomy/ Frenulectomy’) is a minor surgical procedure that improves restricted tongue movement by releasing a short or tight frenulum. It is generally done in the doctor’s office or a hospital.

Who requires tongue-tie surgery?

• Infants with tongue-tie, which makes breastfeeding difficult and impacts the overall health of the infant
• Children with tongue-tie whose oral hygiene, appearance or speech is affected
• Children or adolescents with tongue-tie who are uncomfortable with their appearance and spacing between their lower front teeth⁴

At what age can it be done?

Tongue-tie surgery can be done at any age, depending on the condition and accompanying challenges experienced:

• In infants: Is done within the first few weeks of life if it causes significant breastfeeding difficulties
• In toddlers: if it is identified later, or affects maintaining the cleanliness and hygiene of the teeth, then the surgery can be performed
• In children and adolescents: If there are any significant speech issues, difficulty in swallowing or poor oral hygiene, tongue-tie surgery can be performed
• In adults, any aesthetic or functional challenges may indicate tongue-tie surgery

How is it done?

• A doctor will do a thorough examination to diagnose the condition. Depending on the extent of the tongue-tie, and after consulting a lactation consultant, they recommend tongue-tie correction surgery
• In infants, anaesthesia is generally not used
• The frenulum is released using a small cut or incision, which improves tongue movement 
•  Surgical scissors are normally used, but a laser may be considered based on circumstances and age
• The procedure is quick, hardly taking a minute, done by conventional methods, but may take a little longer with the use of lasers

How long does the recovery take?

Initial recovery starts within a few hours. Depending on the severity of the tongue tie, complete healing may take up to a few weeks.

Can it relapse or reattach if not cared for properly?

 If regular stretching exercises and post-operative care are not taken, scar tissue may form, possibly restricting tongue movement.

What is post-operative care?

Post-operative care is any care taken after surgery,including pain management, wound management, and hygiene maintenance that speeds up healing.

What to expect after the surgery?

• Within a few hours after surgery, Doctors encourage mothers to breastfeed their babies immediately after a tongue-tie surgery to comfort the baby and reduce bleeding
• Within the first few days, Mild discomfort or pain, mild bleeding or swelling may be present
• 1-2 weeks after surgery: Latching and breastfeeding improve significantly, stretching exercises and massage show improved healing
• 1 month after surgery: healed incision site, no pain or discomfort, normal latching and breastfeeding, improved tongue movements in infants. Children and adults can return to a regular diet and activities

Post-operative care

Duration: Immediate care begins after surgery and continues in the first 24 hours. 

Post-operative management⁵

• Pain management: Use of prescribed medications or over-the-counter pain relievers
• Bleeding management: The bleeding usually stops on its own and requires no additional measures. If bleeding persists, applying firm pressure using clean gauze can stop the bleeding
• Oral care after surgery: Gentle cleaning with saline solution or an extra soft toothbrush
• Dietary restrictions: For infants, initiate breastfeeding after surgery. For children and adults, start with cold liquids and then slowly reintroduce solid foods
• Monitor for complications: Check for signs of infection, excessive swelling, or difficulty breathing

Post-operative care tips

Exercises for optimal healing

Your doctor will recommend certain massages and stretching exercises to improve the tongue's mobility and prevent scar tissue from forming. To speed up the recovery, continue doing the exercises as per your doctor’s recommendations.

When to seek medical help?

Seek immediate medical help in cases of unusual pain, persistent bleeding or swelling, discharge from the incision site, fever or signs of infection.

Summary

Tongue-tie or Ankyloglossia is defined as restricted tongue movement due to a short, thick lingual frenulum attachment. This condition has been present since birth and is believed to be caused by genetic changes.

Post-operative care after tongue-tie surgery is essential for healing and preventing complications. Pain management is key, with infants receiving prescribed pain relief and older children and adults using over-the-counter medications. For feeding, infants can continue breastfeeding or formula feeding, while older patients should stick to soft foods and liquids.

Tongue exercises are crucial to prevent reattachment, with gentle massages for infants and prescribed stretches for children and adults. Maintaining good oral hygiene is important, and patients should gently clean their mouths after feeding and brush their teeth carefully to avoid infection.

Monitoring for signs of infection, such as swelling or fever, is essential, and follow-up appointments with the healthcare provider ensure proper healing. Speech therapy may be recommended if issues with speech or swallowing occur during recovery.