What is Tongue-Tie Surgery?

Tongue-tie release is a procedure that involves cutting tissue under the tongue, usually because of an infant’s problems with breastfeeding. It has been around for generations. But now the American Academy of Pediatricians has released a report that warns this kind of surgery is often unnecessary and overdone.

Research for the AAP report, which was published in the journal Pediatrics, began in 2015, when member pediatricians noted a significant increase in tongue-tie procedures, including requests from parents.

Researchers found a steep spike in both diagnoses of ankyloglossia and lingual frenotomy procedures that enable better movement of the tongue — in fact, a stunning 110.4% increase between 2012 and 2016. 

However, hard data on the actual number or percentage of babies diagnosed with tongue-tie can be challenging to come by. Those that have been published vary greatly. Different studies conducted in various countries, including the U.S., reveal that as few as 1.7% of babies and as many as 10.7% are diagnosed every year. But what was once a simple surgery effectively done with scissors now often involves the use of lasers to vaporize the issue, sometimes to the tune of hundreds of dollars.

This does not surprise Ramzi Younis, M.D., FAAP, FACS, a pediatric otolaryngologist with the University of Miami Health System.  More patients are being referred to his office by pediatricians and lactation experts.

“It’s not just in Miami,” Dr. Younis says, “but all over the country and worldwide. Clinics [many in California] have been set up for this alone.”

He says he suspects a financial motive, particularly in the higher-cost use of lasers. When researchers compared demographics, “children with ankyloglossia or frenotomy were more often male, privately insured, and from higher median-income zip codes.”

Dr. Younis believes the increase may be due, in small part, to more awareness of the condition in both the lay and medical communities.

Social media often feature personal testimonies and targeted advertising of frenotomy services, but some content urging surgical remedies can contain misinformation.

In fact, the AAP report warns that parents “may have trouble determining which information is reliable and unbiased.”

In addition, renewed interest in breastfeeding has also meant more mothers choosing to nurse, and not surprisingly, there has been a corresponding increase in reported breastfeeding issues. Most evaluations of ankyloglossia come about when a nursing mother reports her baby has difficulty breastfeeding or latching on. Children need good tongue mobility to nurse properly, and a tight or too-short band connecting the tongue tip to the mouth can make latching on more difficult.

In such cases, a frenotomy is usually recommended, but, as Dr. Younis says, the procedure might not necessarily help the struggling mother and infant. 

Nursing may continue to be difficult.

“Mothers have managed to nurse without this [surgery] for generations,” he points out. “The question we should be asking is if this is the best way to take care of the problem.”

The band connecting the tongue to the bottom of the mouth is a normal part of our anatomy, he adds.  The authors of the AAP report say that only a fraction of infants with tongue ties — namely those with more severe tethering — should undergo surgery. What’s more, the use of expensive lasers instead of traditional scissors is unnecessary, no matter how much the gadgetry is touted as leading-edge technology. As Dr. Younis says:  “Laser is a nice tool, but in this case, it’s a marketing and selling tool. It doesn’t offer any advantage.”

Report authors also suggest that nursing mothers try alternatives before pursuing surgery, which sometimes causes sore mouths and pain.

A lactation consultant can suggest different positioning techniques to help with nipple pain and latching problems.

The AAP is the third medical group to issue professional recommendations about tongue tie surgery. Four years ago, the American Academy of Otolaryngology-Head and Neck Surgery released a statement that warned tongue-tie was being overdiagnosed in some places. The group also said there wasn’t evidence to favor lasers, a more expensive technique, over others.         

A year later, the International Academy of Breastfeeding Medicine called for more research into tongue-tie treatment, underscoring that treatment decisions “require a high level of clinical skill, judgment, and discernment.”

Like other statements, the AAP report recommends a teamwork approach to tongue-tie surgery choices, including consultation with pediatricians, lactation experts, and surgeons.

That said, Dr. Younis says parents should not “overthink” the decision, as the surgery, with scissors is simple, safe and straightforward.

“Don’t hesitate to do it [frenotomy] if it’s needed,” he adds. “We shouldn’t lose sight of the benefits for some infants.”

Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is an acclaimed author and journalist who has worked at The Miami Herald, The Miami News, and The Palm Beach Post.

Tags: breastfeeding, breastfeeding care, Dr. Ramzi Younis, pediatric ENT, tongue surgery