Tongue-tie Management: The Surgeon’s Role in a Collaborative Team – From Newborns to Older Patients

Surgeons are central to the successful management of ankyloglossia, working as part of a collaborative team that supports patients across all ages. In this lecture, I will draw on over 25 years of clinical experience, during which I have performed more than 35,000 surgical tongue-tie releases—both frenotomies and frenectomies—using scissors in patients ranging from newborns to adults.

The presentation will focus on age-specific approaches to anesthesia and analgesia during tongue-tie procedures. While high-level evidence remains limited, I will present practical protocols supported by current literature and extensive clinical experience. Emphasis will be placed on the use of topical and infiltrative local anesthetics, with discussion of dosage, technique,  and other considerations across different age groups. The role of adjuncts such as nitrous oxide and mild sedation for behavior and pain management will also be covered.

Additionally, the talk will highlight how integrating surgical care within a multidisciplinary framework—through coordination with lactation consultants, SLP’s , bodyworkers, and other professionals — can optimize timing, comfort, and outcomes.

Dr. Eyal Botzer graduated from the Hebrew University School of Dental Medicine in 1990 and completed his Postgraduate Program in Pediatric Dentistrythere in 1995. Since 1997, Dr. Botzer has directed the Pediatric Dentistry Clinic at the Tel Aviv Sourasky Medical Center, focusing on neonates with craniofacial anomalies. A founding member and former board member of the IATP, he has been a leader in tongue-tie research since 2000.