What is a Tongue Tie (ankyloglossia)?

The tissue under the tongue that connects the tongue to the floor of the mouth is called a frenulum. When this tissue is either too short, tight or thick, it can restrict the natural movement of the tongue. 

TOTS: "Tethered Oral Tissues"

What is the cause of TOTS?

Tongue tie is caused by the incomplete separation of the tongue from the floor of the mouth in utero. The exact cause of TOTS is unknown though researchers believe there is a genetic component. 

Troubles with feeding as an infant is often the first red flag one may experience in a lifetime. The position of our tongue and how it functions plays an important role in the growth and development of our craniofacial structures including our airway.

What symptoms can be caused by a tongue tie?

• Difficulty with breastfeeding in infancy
• Low tongue posture
• Crooked or crowded teeth
• Swallow dysfunction
• Clenching and grinding
• Jaw pain or discomfort
• Frequent headaches
• Speech difficulties
• Mouth breathing
• Poor sleep
• Dental caries
• Posture maladaptation
• Neck/shoulder Tension 
• Acid reflux, heartburn, indigestion 
• Picky or messy eating
• Frequent ear infections
• Strong gag reflex

How are TOTS treated?

After infancy the approach to correct tethered tissues is slightly different. The tongue is a muscle and often needs help or support learning it's new intended muscle pattern and rest posture after a tongue tie release. A Functional Frenuloplasty is the term referring to a tongue tie release done in conjunction with a Myofunctional Therapy program. This approach honors the changes that occur during a tongue-tie release and prepares the body for acceptance and optimal healing post-treatment. The most recent research has provided high levels of success when tethered tissues are approached and treated collaboratively.  

A Functional Frenuloplasty is a minor surgical procedure that releases the restrictive bands of tissue under the tongue. Dr. Slovack will determine when the release is complete based on a patients tongue range of motion ratio, and the adaptation of surrounding structures, such as the floor of the mouth. It is important to understand that a tongue tie should not be released without confirmation of adequate tongue space and comfortable nasal breathing. 

Below is visual reference of the Tongue Range of Motion Ratio grading system to assess both the front and the back of the tongues range and mobility. Not all tongue ties are obvious to the untrained eye. When diagnosing is it important to understand muscle compensation patterns and how the body compensates for those patterns.