Tongue-Tie Surgeries in Babies on the Rise: American Academy of Pediatrics Report

The AAP notes a growing trend in tongue-tie diagnoses and surgical interventions in babies despite lack of clinical consensus on treatment options.

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The American Academy of Pediatrics (AAP) issued new recommendations on Monday for treating and diagnosing tongue-tie after noting a rise in diagnosis and surgeries in babies in recent years.

Ankyloglossia, or “tongue-tie,” is a natural variation of oral structure, the doctors wrote. However, in some babies, it may interfere with feeding when the tongue frenulum, the tissue connecting the tongue to the floor of the mouth, is too short or tight to allow the necessary range of motion.

In these cases, treatments are considered.

“There is a lack of consensus for treatment of ankyloglossia, leading to wide practice variation in the United States and internationally,” said the clinical report.

Despite the lack of consensus, diagnoses and surgeries to remove or snip the frenulum have recently become more common, leading some pediatricians to question whether babies are being overdiagnosed.

Removal of the frenulum through tongue-tie surgery (frenectomy) is reported to be quick and minimally uncomfortable since there are few nerve endings or blood vessels in the frenulum. Complications are rare, though they can include bleeding, infection, damage to the tongue or salivary glands, and scarring.

Rise in Diagnosis and Treatment

There has been a marked increase in diagnoses of this condition in recent years, with almost 10 times more cases in 2012 than in 1997, according to studies cited in the report. Cases more than doubled between 2012 and 2016. About 70,000 cases were reported in 2016, up from about 5,000 in 1997.

Previous studies mentioned in the report found that the prevalence of tongue-tie surgeries increased in tandem with the rapid increase in diagnoses.

“These significant increases in the incidence of ankyloglossia diagnoses and the rates of frenotomy performance may be attributable to true increased incidence, improved diagnostic accuracy, or overdiagnosis,” the AAP authors wrote.

Diagnosis and Treatment

A pediatrician diagnoses tongue-tie; however, the condition may be suspected if mothers experience pain during breastfeeding or if the baby latches poorly or does not gain weight sufficiently.

The most common treatment for tongue-tie is infant frenotomy, in which the tissue connecting the tongue to the floor of the mouth is cut. Lasers have been used increasingly in recent years, but “there is insufficient evidence” to support claims that one technique, such as laser, is superior to another, according to a 2020 clinical consensus statement.

Controversy Over Frenotomy Procedures

The frenulum, also known as the lingual frenulum, has never had its detailed anatomy described, and “no anatomical basis has been proposed for the individual variability in frenulum morphology,” according to a 2019 study published in Clinical Anatomy.

The authors wrote that due to “clinical uncertainty around what is normal and abnormal frenulum anatomy,” it is essential to understand each person’s frenulum and its relationship to its anatomy.

According to the Clinical Anatomy study authors, intense social media debates have brought frenotomy procedures into question, especially if they do not yield improvements. Babies may then be subjected to more frenotomies to correct the problem.

Frenulum surgeries run the risk of potential injury to nerve branches, the AAP noted. Nerve injuries could compromise sensation in the tongue, which could be overlooked in infants. Injuries to branches of the lingual nerve could be of particular concern in infants having difficulty with breastfeeding.

The AAP clinicians listed several recommendations, notably that babies whose tongue-tie does not affect their feeding do not require surgery. Certain tongue-tie conditions, in which the tissue connects further back on the tongue, are currently poorly defined, and surgical intervention is not justified in these cases.

The authors said a standardized way to identify and classify types of tongue-tie, as well as further research that evaluates long-term health consequences, severity, and risks of feeding problems, are needed.