Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Ankyloglossia (tongue-tie) in infants and children

Glenn C Isaacson, MD, FAAP
Section Editor
Anna H Messner, MD
Deputy Editor
Carrie Armsby, MD, MPH


Ankyloglossia, or tongue-tie, is a congenital anomaly in which a short, lingual frenulum or a highly-attached genioglossus muscle restricts tongue movement (ie, restrictive lingual frenulum) (picture 1A-B) [1]. The definition of ankyloglossia is not standardized and there is wide variation of opinion regarding its clinical significance and optimal management [2,3].

Ankyloglossia will be discussed below. Other congenital anomalies of the tongue are discussed separately. (See "Congenital anomalies of the jaw, mouth, oral cavity, and pharynx".)


Published information about ankyloglossia largely consists of case series and observational studies [4,5]. Depending upon the study population and criteria used to define ankyloglossia, the reported prevalence varies from <1 percent to 10.7 percent [1,4,6-14]. The variation in reported incidence may be attributed in part to the lack of a uniform definition and objective grading system for tongue-tie [15]. Several authors have tried to develop standardized measurement techniques and norms (figure 1 and figure 2) [15,16]. Most series identify an increased frequency in boys with a male to female ratio of 1.5:1 to 2.6:1 [4]. While most cases of ankyloglossia are sporadic, mutations in the T box transcription factor TBX22 may lead to heritable (X-linked) ankyloglossia with or without cleft lip, cleft palate, or hypodontia [17].


Clinical features of ankyloglossia may include [1,15,18]:

Abnormally short frenulum, inserting at or near the tip of the tongue (picture 1A-B)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jun 9, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Mueller DT, Callanan VP. Congenital malformations of the oral cavity. Otolaryngol Clin North Am 2007; 40:141.
  2. Messner AH, Lalakea ML. Ankyloglossia: controversies in management. Int J Pediatr Otorhinolaryngol 2000; 54:123.
  3. Brinkmann S, Reilly S, Meara JG. Management of tongue-tie in children: a survey of paediatric surgeons in Australia. J Paediatr Child Health 2004; 40:600.
  4. Hall DM, Renfrew MJ. Tongue tie. Arch Dis Child 2005; 90:1211.
  5. National Institute for Health and Clinical Excellence (NICE) interventional procedure guidance [IPG149]. Division of ankyloglossia (tongue-tie) for breastfeeding. Available at: https://www.nice.org.uk/guidance/ipg149/chapter/1-Guidance (Accessed on June 09, 2016).
  6. Cinar F, Onat N. Prevalence and consequences of a forgotten entity: ankyloglossia. Plast Reconstr Surg 2005; 115:355.
  7. Messner AH, Lalakea ML, Aby J, et al. Ankyloglossia: incidence and associated feeding difficulties. Arch Otolaryngol Head Neck Surg 2000; 126:36.
  8. Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia: methodologic review. Can Fam Physician 2007; 53:1027.
  9. Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005; 41:246.
  10. Ricke LA, Baker NJ, Madlon-Kay DJ, DeFor TA. Newborn tongue-tie: prevalence and effect on breast-feeding. J Am Board Fam Pract 2005; 18:1.
  11. Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics 2002; 110:e63.
  12. Garcia-Pola MJ, Garcia-Martin JM, Gonzalez-Garcia M. Prevalence of oral lesions in the 6-year-old pediatric population of Oviedo (Spain). Med Oral 2002; 7:184.
  13. Flinck A, Paludan A, Matsson L, et al. Oral findings in a group of newborn Swedish children. Int J Paediatr Dent 1994; 4:67.
  14. Sedano HO, Carreon Freyre I, Garza de la Garza ML, et al. Clinical orodental abnormalities in Mexican children. Oral Surg Oral Med Oral Pathol 1989; 68:300.
  15. Lalakea ML, Messner AH. Ankyloglossia: does it matter? Pediatr Clin North Am 2003; 50:381.
  16. Ruffoli R, Giambelluca MA, Scavuzzo MC, et al. Ankyloglossia: a morphofunctional investigation in children. Oral Dis 2005; 11:170.
  17. Kantaputra PN, Paramee M, Kaewkhampa A, et al. Cleft lip with cleft palate, ankyloglossia, and hypodontia are associated with TBX22 mutations. J Dent Res 2011; 90:450.
  18. Muntz HR, Gray SD. Congenital malformations of the mouth and pharynx. In: Pediatric otolaryngology, 4th ed, Bluestone CD, Casselbrant ML, Stool SE, et al (Eds), Saunders, Philadelphia 2003. p.1149.
  19. WALLACE AF. TONGUE TIE. Lancet 1963; 2:377.
  20. Horton CE, Crawford HH, Adamson JE, Ashbell TS. Tongue-tie. Cleft Palate J 1969; 6:8.
  21. Hong P, Lago D, Seargeant J, et al. Defining ankyloglossia: a case series of anterior and posterior tongue ties. Int J Pediatr Otorhinolaryngol 2010; 74:1003.
  22. Wright JE. Tongue-tie. J Paediatr Child Health 1995; 31:276.
  23. Lalakea ML, Messner AH. Ankyloglossia: the adolescent and adult perspective. Otolaryngol Head Neck Surg 2003; 128:746.
  24. Ketty N, Sciullo PA. Ankyloglossia with psychological implications. ASDC J Dent Child 1974; 41:43.
  25. Forlenza GP, Paradise Black NM, McNamara EG, Sullivan SE. Ankyloglossia, exclusive breastfeeding, and failure to thrive. Pediatrics 2010; 125:e1500.
  26. Dollberg S, Botzer E, Grunis E, Mimouni FB. Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. J Pediatr Surg 2006; 41:1598.
  27. Geddes DT, Langton DB, Gollow I, et al. Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 2008; 122:e188.
  28. Power RF, Murphy JF. Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance. Arch Dis Child 2015; 100:489.
  29. Messner AH, Lalakea ML. The effect of ankyloglossia on speech in children. Otolaryngol Head Neck Surg 2002; 127:539.
  30. Williams WN, Waldron CM. Assessment of lingual function when ankyloglossia (tongue-tie) is suspected. J Am Dent Assoc 1985; 110:353.
  31. Fiorotti RC, Bertolini MM, Nicola JH, Nicola EM. Early lingual frenectomy assisted by CO2 laser helps prevention and treatment of functional alterations caused by ankyloglossia. Int J Orofacial Myology 2004; 30:64.
  32. Francis DO, Krishnaswami S, McPheeters M. Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics 2015; 135:e1458.
  33. Chinnadurai S, Francis DO, Epstein RA, et al. Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review. Pediatrics 2015; 135:e1467.
  34. Froom SR, Stewart J. Novel local anaesthetic analgesic technique for tongue-tie. Anaesthesia 2007; 62:97.
  35. Masaitis NS, Kaempf JW. Developing a frenotomy policy at one medical center: a case study approach. J Hum Lact 1996; 12:229.
  36. Griffiths DM. Do tongue ties affect breastfeeding? J Hum Lact 2004; 20:409.
  37. Interventional procedures overview - division of anklyloglossia (tongue-tie) for breastfeeding. www.nice.org.uk/ip279overview (Accessed on June 25, 2008).
  38. Amir LH, James JP, Beatty J. Review of tongue-tie release at a tertiary maternity hospital. J Paediatr Child Health 2005; 41:243.
  39. Isaacson G. Pediatric intracapsular tonsillectomy with bipolar electrosurgical scissors. Ear Nose Throat J 2004; 83:702, 704.
  40. Kaban LB. Pediatric oral and maxillofacial surgery, WB Saunders, Philadelphia 1990. p.131.
  41. Godley FA. Frenuloplasty with a buccal mucosal graft. Laryngoscope 1994; 104:378.