Tongue Tie Surgery in Pune: Frenotomy and Frenuloplasty

What is a tongue tie?

A tongue tie (ankyloglossia) is a short, thick or tight frenulum, the band of tissue under the tongue that joins it to the floor of the mouth. It limits how far the tongue can lift, stick out or move from side to side. When the tongue is pushed out, the tip may look notched or heart-shaped.

Tongue ties are present from birth and are common. Many cause no problems at all.

Possible effects include:

• In babies: difficulty latching onto the breast, long or frequent feeds, clicking during feeds, poor weight gain, and sore or damaged nipples in the mother.
• In children: difficulty with some speech sounds, licking the lips or eating ice cream, and a gap between the lower front teeth in some cases.
• In adults: tongue discomfort, difficulty cleaning the teeth with the tongue, or problems with wind instruments.

Who may benefit, and how is it assessed?

Treatment is considered only when the tie is causing a problem. For babies, guidance recommends that breastfeeding position and attachment are reviewed by a skilled professional first, because many feeding problems improve with support alone.

The assessment looks at:

1. How the tongue moves: lifting, sticking out and moving side to side.
2. The frenulum: its thickness, length and where it attaches.
3. The problem it causes: feeding, speech, eating or comfort.
4. Other causes of the same symptoms, such as speech or feeding difficulties unrelated to the tie.

What are the treatment options?

Option	Suits	Points to consider
No treatment	Ties that cause no problems	Many never need treatment
Feeding support	Babies with feeding difficulty	Often helps without surgery
Frenotomy	Young babies with feeding problems	Quick snip; minimal bleeding; NICE found no major safety concerns
Frenuloplasty	Older children and adults; thick ties	Fuller release with stitches; local or general anaesthesia
Speech therapy	Speech concerns	Often needed with or instead of surgery

How is tongue tie surgery performed?

Frenotomy (babies)

1. The baby is wrapped and the head is held steady.
2. The tongue is lifted, and the thin frenulum is divided with sterile scissors.
3. The baby is fed straight away, which helps settle them and stops any small bleeding.

Frenuloplasty (older children and adults)

1. Local anaesthesia for cooperative older children and adults; general anaesthesia for young children.
2. The frenulum is released, avoiding the ducts and vessels under the tongue.
3. The wound is closed with dissolvable stitches, sometimes in a zig-zag pattern to lengthen the tissue.

How should you prepare, and what should you ask?

• For babies, have a feeding assessment first.
• For speech concerns, consider a speech and language assessment.
• Tell the doctor about any bleeding problems in the family.

Questions to ask:

• Is the tie causing the problem, or could something else be responsible?
• Frenotomy or frenuloplasty: which suits this age and tie?
• Will tongue exercises or speech therapy be needed afterwards?

What is recovery like?

Time	What to expect for most patients
Same day	Babies feed straight away; older patients have a numb, sore tongue for a few hours
Days 1-3	Mild soreness; soft foods if needed
Week 1-2	A white patch under the tongue is normal healing; stitches dissolve
Weeks 2-6	Tongue exercises or speech therapy as advised

What are the risks?

• Bleeding, usually minor and stopped with pressure or feeding.
• Infection, uncommon.
• Pain or feeding refusal for a short time.
• Scarring and re-tightening of the frenulum.
• Injury to the ducts or nerves under the tongue, rare.
• No improvement if the symptoms had another cause.

Seek prompt help for bleeding that does not stop with pressure, a baby who will not feed, fever or swelling under the tongue.

What results can you expect?

Many babies feed more comfortably after frenotomy, although the evidence for long-term breastfeeding benefit is limited. Older children and adults usually gain tongue movement after frenuloplasty, especially with exercises afterwards.

What happens if a tongue tie is not treated?

Many tongue ties never cause a problem, and leaving them alone is safe. Some divide, stretch naturally, or tear on the lower teeth as a baby starts to chew. If a baby is feeding and gaining weight well, a watch-and-wait approach is reasonable.

When a tie does affect feeding, waiting carries real costs. A baby may struggle to stay attached, feed for long periods and gain weight slowly, while the mother may develop sore, damaged nipples, and her milk supply can fall. Help from a skilled feeding professional often improves attachment without any procedure.

In older children, most speak normally despite a tie. It can affect a few sounds, but it is not possible to predict which children will be affected, so speech is usually assessed at around three or four years. Release can be done later in life if a problem appears.

Common myths about tongue tie

• “A tongue tie makes a child late to start talking.” Most children with a tie speak normally; late talking usually has other causes and needs a speech assessment.
• “Every baby with a visible frenulum needs a snip.” Everyone has a frenulum, and only a tight one that causes a problem is treated.
• “Release will make speech clear straight away.” If a tie has affected certain sounds, speech therapy is often still needed afterwards.
• “Tongue tie release will solve every feeding problem.” Feeding difficulties have many causes, so the procedure does not always improve feeding.

What affects the cost of tongue tie surgery in Pune?

• Age and procedure: frenotomy or frenuloplasty.
• Anaesthesia: none, local or general.
• Facility charges for day care.
• Follow-up visits and any speech therapy.