Oral ties, such as tongue-tie (ankyloglossia) and lip-tie, are congenital conditions that restrict the movement of the tongue or lip due to tight or thick tissue attachments.

Tongue-tie occurs when the lingual frenulum—a short, thick, or tight band of tissue—anchors the tip of the tongue to the floor of the mouth. Similarly, a lip-tie refers to an overly tight or thick tissue connection between the upper lip and the gum.

• Restricted tongue movement

• Difficulty breastfeeding or nipple damage

• Swallowing and digestive issues

• Speech difficulties

• Challenges with oral hygiene

• Watch and wait: Some children’s ties or symptoms resolve as they get older and grow

• Non-surgical: Including support from lactation consultants, Body work or speech therapy

• Frenotomy: A quick procedure where the frenulum is released using scissors or laser

• Frenuloplasty: A more extensive surgery generally requiring anaesthesia

Oral ties are typically diagnosed by trained professionals through a combination of screening tools to assess the tongue's appearance and mobility, along with a physical examination.

Not all oral ties require treatment. Therefore, it is essential to consider symptoms, physical findings, and the patient’s needs as a whole before determining the appropriate course of management.

A frenotomy is a quick and straightforward procedure in which the frenulum/oral tie is released using scissors, a scalpel, or a laser.

The decision to release an oral tie, such as a tongue-tie or lip-tie, can be a complex and sometimes controversial topic. While some healthcare professionals advocate for immediate correction, others recommend a more conservative approach with observation.

The choice to proceed with treatment should be guided by the severity of symptoms, their impact on daily life, and careful consultation with qualified healthcare professionals. These may include lactation consultants, speech therapists, specialised dentists, or trained doctors who can help determine the most appropriate course of action.

In many cases, surgical intervention is not required. However, if it is recommended, Dr Carly is highly skilled in performing the scissor technique. During this procedure, the infant is given a sucrose (sugar) solution for pain relief, and the frenulum is gently divided using surgical scissors with minimal distress.

The procedure used to treat an oral tie, is generally considered low-risk, but complications can occur.

Some of the risks include:

• Bleeding

• Discomfort

• Infection

• Damage to other structures

• Residual tissue

• Re-attachment

• Oral aversion

Parents should discuss potential benefits, risks and necessity of the procedure with their healthcare provider before proceeding.

After a lingual frenotomy, infants usually breastfeed immediately and some individuals notice an immediate improvement in function, such as better breastfeeding or tongue mobility. Others may see gradual improvements over 1–2 weeks as healing progresses. In some cases, however, there may be limited to no improvement.

The area itself typically begins to heal within 1–3 days, with a white patch forming as part of the natural healing process.

Stretching exercises will be recommended to keep the released site supple during healing and will commence on the same day.

The procedure and the recovery are generally pain free but simple analgesics such as paracetamol can be used if necessary.