Tongue Tie Release (Frenuloplasty)

What the Operation Is

A tongue tie (ankyloglossia) is a restriction of tongue movement caused by a tight or thick lingual frenulum — the small fold of mucosa connecting the underside of the tongue to the floor of the mouth. While most attention is given to infant tongue tie affecting breastfeeding, adult tongue tie can contribute to difficulties with swallowing, speech, sleep-disordered breathing, snoring, and obstructive sleep apnoea, as well as orthodontic and TMJ-related problems.

Tongue tie release is performed under general anaesthetic. My preferred technique is a scissor dissection with post-operative dissolving sutures. The frenulum is divided in a Z-plasty or diamond shape to maximise tongue mobility while minimising scarring. Dissolving sutures hold the tissues in the new position while healing takes place.

Risks & Complications (Zaghi data)

Published statistics on the risks of this procedure come from a large series by Dr Zaghi and colleagues. I have not modified these figures; you are entitled to know them.

• Post-operative pain. Approximately 45% of patients have meaningful pain for three to five days, with peak severity up to 8.5 out of 10 on a self-rated scale. Paracetamol and ibuprofen on a regular staggered schedule are usually sufficient.
• Bleeding. Approximately 12–13% experience bleeding after the operation. Most is minor and self-limiting; rarely, further treatment is needed.
• Numbness or reduced sensation at the tip of the tongue. Approximately 5% (1 in 20 cases) experience this, lasting around two weeks in most cases. Less than 1% have persistent altered sensation beyond a year.
• Damage to the salivary glands. Approximately 3.4% have some involvement of the submandibular salivary gland ducts that run close to the floor of the mouth — typically inflammation, swelling, increased salivation, or jetting of saliva on tongue lifting or eating. Most settle within one to two weeks.
• Worsened tongue mobility requiring revision. Approximately 3.2% of patients have worse mobility after the first operation (due to restrictive scar tissue) and need a revision procedure to excise the scar. A further 3.4% of patients see some improvement but elect to proceed with a second-stage frenuloplasty to further improve mobility.
• Worsened overall health. Approximately 0.6% (less than 1%) of patients feel their overall health is worse after this operation.

Aftercare

• Painkillers. Paracetamol and ibuprofen on a regular staggered schedule for the first week. Take them on time even if pain feels manageable.
• Tongue stretches. Following surgery, regular tongue stretches several times daily are essential to prevent scar contracture and preserve the gain in mobility. I will provide a written stretch protocol at discharge.
• Eat normally. Soft food for the first 24–48 hours; progress to normal food as comfort allows. Avoid very hot or spicy food for the first few days.
• Mouthwash. A mild antiseptic mouthwash (chlorhexidine) for the first week helps reduce infection risk.
• Time off work: usually 3–5 days.
• Avoid strenuous exercise for one week.
• Myofunctional therapy. Many patients benefit from working with a myofunctional therapist before and after surgery to maximise the functional gains in tongue mobility.

When to Call the Hospital or Attend A&E

• Fresh red bleeding from the mouth that does not settle.
• Worsening pain or swelling after the first few days.
• Fever or foul-smelling breath suggesting infection.
• Persistent worsening of tongue mobility despite stretches.

Booking, Consent and Next Steps

If you are considering tongue tie release, the secretarial team can arrange a consultation. See also Snoring & Sleep Apnoea, Lingual Tonsil RFA, and Throat Exercises.