Social Skills | Speech Language Services

Tongue Tie

Tongue tie (ankyloglossia) is a condition present at birth that restricts the tongue's range of motion and is present in approximately 5% of the population.

With tongue tie, an unusually short, thick or tight band of tissue (lingual frenulum) tethers the bottom of the tongue's tip to the floor of the mouth. In trying to understand how best to treat children with tongue tie, practitioners have developed a classification system to describe tongue tie.

At Sally Bober & Associates, we do a screening for possible tongue-tie, lip or cheek ties. Approximately 50-70% of our feeding population has an undiagnosed restriction. We work with a team of dentists, ENTs and neurochiropractics to perform pre and post frenectomy care.

Classifying Tongue Tie

Most practitioners use a classification where the tongue tie is given a grade of 1, 2, 3, or 4. Classically, class 1 and 2 are thought of as anterior, whereas class 3 and 4 are posterior. Unlike cancer grading, where stage 1 is minimal disease and stage 4 is severe disease, that distinction does not apply for grading the severity of tongue ties. Instead, the tongue tie classification system is merely a description of where the tie attaches to the tongue.

Class 1 Tongue Tie:
This is the classic heart-shaped tongue most familiar to untrained physicians. The tie inserts into the tip of the tongue.

Class 2 Tongue Tie:
This tie inserts just behind the tip of the tongue. We don't see a heart-shaped tongue, but the tie is still clearly visible.


Class 3 Tongue Tie:
A posterior tongue tie where a thin membrane is still present. This membrane is distinguishing Class 3 and 4 classifications.]

Class 4 Tongue Tie:
The front and sides elevate, but the mid-tongue cannot. There is no membrane present. This is the most commonly missed tongue tie.


Eating Difficulties Associated with Tongue Tie

In best case scenarios, tongue tie is diagnosed during infancy when issues with breastfeeding are easily identified. However, for people who are not diagnosed at this age, eating difficulties can persist. Common signs of tongue tie include:

Breathing Difficulties Associated with Tongue Tie

Speech-language pathologists can intervene and help correct the issues that arise from structural anomalies, such as tongue tie, and other orofacial myofunctional disorders.

Even small disturbances in breathing can have substantial, negative effects on functioning, health and behavior. Breathing effects are particularly important during childhood development. This is illuminated on the caseloads of pediatric speech-language pathologists when we see airway function disorders (AFDs).

Fortunately, for most of us, breathing occurs automatically and unimpeded, without conscious effort. Unfortunately, in today’s fast-paced, achievement-driven world, healthful and proper breathing is often taken for granted—especially at night, during sleep.

For more on the relationship between AFDs and tongue restrictions, enlarged tonsils/adenoids or hypersensitive gag reflex which can prove to cause negative effect with feeding, refer to Healthy Breathing ‘Round The Clock by Nicole Archambault, EdS, MS, CCC-SLP.

Tongue Tie Correction: Frenotomy

A frenotomy or frenectomy is a procedure used to correct tongue ties. In general, the procedure is very well-tolerated by children. Utilizing laser surgery techniques, frenotomy can be completed without general anesthesia and takes a few minutes to complete.

Aftercare for the wound and stretching the mouth are the two main components in successful post-procedure healing of frenotomies. The main risk of a frenotomy is that the mouth heals so quickly that it may prematurely reattach at either the tongue site or the lip site, causing a new limitation in mobility and the persistence or return of symptoms. To help counter this, stretching and wound care procedures will be provided by the physician performing the procedure.