Tongue Tie Treatment in Sydney (Ankyloglossia)

Tongue tie (ankyloglossia) is a congenital condition where the lingual frenulum, the strip of tissue connecting the underside of the tongue to the floor of the mouth, is shorter, tighter, or thicker than usual. This restricts the tongue's range of movement and can affect breastfeeding in infants, speech development in children, and oral function in adults. At Central Sydney ENT, our FRACS-qualified surgeons assess and treat tongue tie across all age groups.

Signs and Symptoms

In newborns and infants:

Difficulty latching during breastfeeding
Clicking or smacking sounds during feeds
Prolonged feeding sessions with poor milk transfer
Poor weight gain or faltering growth
Maternal nipple pain, damage, or recurrent mastitis
The tongue appears heart-shaped or notched at the tip when the baby cries

In older children:

Difficulty with articulation of certain sounds (l, r, t, d, n, th, s, z)
Inability to lick the lips or touch the tongue to the roof of the mouth
Messy eating or difficulty managing certain food textures
Difficulty playing wind instruments

In adults:

Speech articulation difficulties that have persisted since childhood
Difficulty with oral hygiene (unable to sweep food debris with the tongue)
Jaw pain or tension from compensatory tongue movement patterns
Social embarrassment from restricted tongue movement

Diagnosis

Diagnosis of tongue tie is made through clinical examination by an experienced ENT surgeon. The assessment includes:

Visual inspection: Examining the frenulum's attachment point, thickness, and length, and observing tongue mobility including elevation, protrusion, and lateralisation.

Functional assessment: In infants, observing a breastfeed or discussing feeding history with the mother and lactation consultant. In older children, assessing speech and working with a speech pathologist when needed.

Grading: The severity of tongue tie can be graded using classification systems that assess the degree of restriction and its functional impact, helping guide treatment decisions.

Treatment Options

Observation: Not all tongue ties require treatment. If the tie is mild and not causing functional problems, monitoring may be recommended with reassessment if issues develop.

Frenotomy (tongue tie division): A simple, quick procedure where the frenulum is divided with sterile scissors. In very young babies, this can be performed in the clinic with minimal discomfort, as the frenulum has few nerve endings and minimal blood supply at this age. The baby can usually breastfeed immediately afterward.

Frenuloplasty: For older children and adults, or for thicker frenula, a more formal surgical release may be performed under local or general anaesthetic. This involves dividing the frenulum and closing the wound with dissolvable stitches to achieve a more complete release and reduce the chance of reattachment.

Speech therapy: For children with established speech patterns affected by tongue tie, speech therapy before or after the procedure helps maximise the benefit of the release. Central Sydney ENT has on-site speech pathology services.

Lactation support: For infants, working with a lactation consultant before and after the procedure is an important part of the treatment plan to optimise feeding outcomes.

When to See an ENT Specialist

A newborn with persistent breastfeeding difficulties despite lactation support
A child with speech difficulties and a visibly restricted frenulum
Referral from a paediatrician, GP, midwife, or lactation consultant
An adult with functional limitations related to tongue movement
Uncertainty about whether a tongue tie is significant and needs treatment

Our Specialists

Tongue tie assessment and treatment at Central Sydney ENT is provided by our team of FRACS-qualified surgeons, with speech pathology support for functional assessment and post-procedure therapy. Our paediatric ENT specialists, including Dr Alexander Zhang and Dr Arjuna Ananda, have extensive experience managing tongue tie in all age groups. Appointments are available at our Burwood main practice and satellite locations.

Related conditions: Peritonsillar Abscess • Laryngopharyngeal Reflux

Related procedures: Paediatric ENT • Tonsils & Throat

Frequently Asked Questions

What is tongue tie? +

Tongue tie (ankyloglossia) is a condition where the lingual frenulum, the strip of tissue connecting the underside of the tongue to the floor of the mouth, is unusually short, tight, or thick. This restricts the tongue's range of movement and can affect breastfeeding, speech, eating, and oral hygiene.

At what age should tongue tie be treated? +

Tongue tie can be treated at any age. In newborns with feeding difficulties, a simple frenotomy can be performed within the first few weeks of life. Older children may be referred if tongue tie is affecting speech development. Adults can also benefit from treatment if the restriction causes functional problems.

Does tongue tie division hurt? +

In very young babies (under a few months), frenotomy is a quick procedure that causes minimal discomfort, as the frenulum has few nerve endings and little blood supply. Older children and adults typically have the procedure under local or general anaesthetic, so they do not feel pain during the division.

Can tongue tie cause speech problems? +

Yes, a significant tongue tie can affect articulation of certain sounds, particularly 'l', 'r', 't', 'd', 'n', 'th', 's', and 'z'. However, not all children with tongue tie develop speech issues. An assessment by an ENT surgeon and speech pathologist can determine whether the tie is contributing to speech difficulties.

How do I know if my baby has tongue tie? +

Signs in babies include difficulty latching during breastfeeding, clicking sounds while feeding, poor weight gain, prolonged feeding times, and nipple pain for the mother. Visible signs include the tongue appearing heart-shaped when the baby cries, or the tongue being unable to extend past the lower gum line.