Tongue tie is the improper positioning of tongue tissue in the mouth, which restricts the tongue's free movement.

Tongue tie occurs when the tissue on the underside of the front of the tongue is positioned too far forward on the tongue, making it difficult to move the tongue. This tissue is called the lingual frenulum.

If the tissue reaches the tip of the tongue, a V-shaped notch may be seen.

Tongue tie may cause feeding problems, tooth problems, and speech problems.

• Can't stick the tongue forward.
• Excessive attachment of tongue to bottom of the mouth
• V-shaped notch in tip of tongue

A doctor can diagnose this condition during a physical exam. The exam will show that the tongue tissue is attached too far forward.

Surgery is seldom necessary. If it is needed, it should be postponed, if possible, until the child is about 9 months old. Occasionally, feeding problems require that surgery be done earlier.

Surgery involves cutting the abnormally placed tissue. If the child has a mild case of tongue tie, the surgery may be done in the doctor's office. More severe cases are done in a hospital operating room. A surgical reconstruction procedure called a z-plasty closure may be required to prevent scar tissue formation.

Surgery, if performed, is usually successful.

The complications are rare, but recurrence of tongue tie, tongue swelling, bleeding, infection, and damage to the ducts of the salivary glands may occur.

If you are concerned that your child may have tongue tie, have your health care provider examine it during a routine well-baby examination.

Behrman RE. Nelson Textbook of Pediatrics. 17th ed. Philadelphia, Pa: WB Saunders; 2004.

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo; Mosby; 2005.