In the past several years, tethered oral tissues have become a hot topic of conversation. The frenulum of the tongue is a fibrous band of tissue shaped like a sail that attaches to the bottom aspect of the tongue and the floor of the mouth. Its’ main purpose is to prevent the tongue from flapping back and closing off the back part of the throat. There are 4 classifications of the frenulum based on where it attaches to the tongue. In some cases, tongue motion can be restricted due to the frenulum attaching to the most forward aspect of the tongue. This is oftentimes diagnosed as a tethered oral tissue because the tongue has limited movement and it cannot perform essential functions.

After babies are born, medical professionals will often evaluate the location of the frenulum. Upon inspection the frenulum will be classified according to location of tongue attachment, rather than assessment of tongue functionality in its’ ability to perform swallowing, sucking, and maintaining an airway. If professionals are not well-versed in regard to tethered oral tissue diagnoses, frenotomies, or releasing of the tethered oral tissue, are over prescribed. Between 1997 and 2012, the number of tethered oral tissue diagnoses increased 10-fold. As a result, the number of tight frenulum releases have increased 10-fold as well. There was an article released in The New York Times 2024 titled ‘Pediatricians Warn Against Overuse of Tongue-Tie Surgeries’, reporting that these procedures have increased 110% since 2012. Now is this increase due to better diagnoses and better awareness or because of an incorrect evaluation?

Research suggests that many medical professionals evaluating these tethered oral tissues do not test the function of the tongue. 50% of tethered oral tissue diagnoses do not affect functionality at all and are completely asymptomatic. So, if a baby is sucking, swallowing, feeding, and maintaining an airway, why are we performing procedures that might not be medically necessary when risks are involved?

One of the biggest risks associated with frenotomies is the damage to the tongue. There is a vast neural network of branches of the lingual nerve on the undersurface of the tongue that provides sensation for the tongue. Think of a fingerprint for the tongue. The problem with these lingual nerve branches is they are invisible to the naked eye. Every frenotomy that is performed risks damage to this neural network essential for sensation to the tongue. Another risk factor with frenotomies is trauma to the upper cervical region of the spine due to the position of the child when the procedure is performed. The infant is placed on his or her back with excessive hyperextension to the neck in order to access the undersurface of the tongue to release the tightened frenulum. With more trauma to this region of the spine, impacts in motor and sensory function to the head and face, as well as immune and endocrine function may be impacted. 

Sometimes this procedure has to be performed to best impact quality of life for the child. If this is the case, parents can perform a number of tongue strengthening exercises and facial massage to help regain proper nervous system functionality. Once the tethered oral tissue is released, it is important to retrain the tongue and other oral tissues how to function now that there is more motion and movement available to the tongue. As always, making sure the child is adjusted pre and post procedure can be vital for recovery and ensuring that the body is functioning as well as possible.

–Dr. Kaytlynn