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Lingual Frenulum: Causes, Symptoms & Treatment

The lingual frenulum is a small fold of mucous membrane beneath the tongue that affects its mobility. A short frenulum can make speaking and breastfeeding more difficult.

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The lingual frenulum is a small fold of mucous membrane beneath the tongue that affects its mobility. A short frenulum can make speaking and breastfeeding more difficult.

What is the Lingual Frenulum?

The lingual frenulum (also known as the frenulum linguae) is a thin fold of mucous membrane that connects the underside of the tongue to the floor of the mouth. It is a normal anatomical structure present in every person. Its primary function is to limit excessive tongue movement and help stabilize the tongue within the mouth.

Problems arise when the frenulum is too short, too thick, or attached too far forward. This condition is medically referred to as ankyloglossia, commonly known as tongue tie, and can significantly restrict tongue mobility.

Causes of a Short Lingual Frenulum

A shortened lingual frenulum is most often congenital, meaning it is present from birth and develops during early embryonic development. In most cases, no specific cause can be identified, though a genetic predisposition may play a role, as the condition can run in families. Boys are more frequently affected than girls.

Genetic factors
Disruption during embryonic development
Family history of tongue tie

Symptoms and Complaints

The symptoms of a short lingual frenulum vary depending on the severity of the condition:

In Infants and Toddlers

Difficulties with breastfeeding (poor latch, ineffective sucking, pain for the mother)
Problems feeding from a bottle
Slow weight gain due to insufficient milk intake

In Older Children and Adults

Speech difficulties, particularly with certain sounds (e.g., “l”, “r”, “t”, “d”)
Difficulties licking, swallowing, or playing wind instruments
Mouth breathing and associated dental misalignment
Jaw pain or tension in the oral region

Diagnosis

A short or problematic lingual frenulum is typically identified through a clinical examination by a pediatrician, dentist, orthodontist, or speech-language pathologist. The evaluation involves assessing tongue mobility and examining the frenulum for its length, thickness, and point of attachment.

Several classification systems exist, such as the Kotlow classification or the Hazelbaker Assessment Tool, to grade the severity of ankyloglossia and determine the need for treatment.

Treatment

Watchful Waiting

Mild cases of tongue tie may improve on their own as the child grows. In these situations, doctors typically recommend regular follow-up examinations to monitor progress.

Speech Therapy

When tongue tie causes speech difficulties, speech-language therapy can help strengthen the tongue muscles and improve articulation and pronunciation.

Surgical Treatment (Frenotomy / Frenuloplasty)

When tongue tie significantly impairs function, a surgical procedure may be recommended. Two main options are available:

Frenotomy (frenulotomy): A simple, low-risk procedure in which the frenulum is cut. In newborns and young infants, it is often performed without general anesthesia.
Frenuloplasty: A more involved surgical procedure in which the frenulum is restructured. It is typically used for older children or adults with more complex cases.

Following either procedure, tongue mobility exercises are often recommended to prevent scar tissue formation and to achieve the best functional outcome.

References

Suter V.G.A., Brägger A., Bornstein M.M. - Ankyloglossia: Overview and Contemporary Management Strategies. Swiss Dent J. 2015;125(6):696-706.
Messner A.H., Lalakea M.L. - Ankyloglossia: controversies in management. Int J Pediatr Otorhinolaryngol. 2000;54(2-3):123-131.
World Health Organization (WHO) - Infant and Young Child Feeding Guidelines. WHO, 2023. Available at: https://www.who.int

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