Implications of Tongue and Lingual Frenulum Anatomy and Function for Tongue‐Tie Management

The tongue’s movements are influenced by the anatomy, especially by the intrinsic and extrinsic tongue muscles, fascia, other muscles of the mouth, chin and neck and the size of the space underneath the tongue blade. A short frenulum has an impact on the latter. The movements are executed partly as a muscular hydrostat with different muscle groups working against each other and by passive impulses from outside – like surrounding muscles, the breast, artificial nipples, fluids or food.

Excellent neural control is required to lead this complex system. Relaxed frequent repetitions of the movements are necessary for improving the movement in many feedback loops. In case of impaired tongue mobility, scissors frenotomy creating a diamond-shaped wound leaves the tissue underneath the cut intact and does not impact the nerves nearby. After scissor frenotomy, the surface area of the diamond-shaped wound in mucosa and fascia heals as a diamond-shaped area, with continuous fascia and mucosa. The aftercare is breastfeeding, feeding and gentle tongue movement exercises. Thus, it is possible to keep infant and parents in a relaxed mode facilitating learning in feedback loops. No stretching is required which would create tension in infant and parents and hinder the learning process of the tongue movement.

After healing after a frenotomy, fascia and mucosa can be lifted again to create a fold, however the front edge of the fold is further posterior, with more of the tongue blade available to move, thus leading to more mobility of the tongue.

Dr. Daniela Karall is a pediatrician with specialization in neonatology and pediatric intensive care, neuropediatrics and inherited metabolic disorders.

Márta Guóth-Gumberger graduated from the Technical University of Munich in civil engineering and worked in Germany and in Sudan. She is an International Board Certified Lactation Consultant (IBCLC) since 1999. Additionally, she has special trainings for accompanying young parents and babies and as a pre and perinatal somatic practitioner.