EVIDENCE AND RESEARCH
The Science
Tongue tie has been described for centuries; however, evidence‑based medicine as we know it today is relatively new. Over the past two decades, the volume and quality of research examining ankyloglossia and frenotomy has increased substantially. This growing body of evidence supports the use of frenotomy to address feeding difficulties and highlights emerging evidence for benefits beyond feeding.
As with any evolving area of clinical research, discussion around tongue tie can evoke strong and sometimes polarised opinions. What matters most is that the conversation is ongoing, informed by data, and continually refined as new evidence emerges. Tongue Tie Galway has compiled key historical and contemporary research below. This page will be updated regularly as new studies are published.
Breastfeeding and Milk Transfer
Geddes et al. – Ultrasound studies of breastfeeding mechanics
Ultrasound imaging of breastfeeding dyads demonstrated that milk flow from the nipple into the infant’s oral cavity coincides with lowering of the tongue and peak intra‑oral vacuum. These findings highlight the critical role of tongue mobility and vacuum generation in effective milk removal.
Effect of frenotomy on milk removal (Geddes et al.)
Infants with ankyloglossia and persistent breastfeeding difficulties demonstrated improved nipple compression, improved attachment, increased milk transfer, and reduced maternal pain following frenotomy. The authors conclude that ankyloglossia should be considered a potential cause of breastfeeding dysfunction.
Randomised Controlled Trials
Randomised controlled trial of tongue‑tie division in infants with feeding problems
Immediate improvement in maternal nipple pain and breastfeeding scores was demonstrated following frenotomy, beyond placebo effects, providing strong evidence for intervention in infants with significant ankyloglossia.
Efficacy of neonatal release of ankyloglossia
This trial showed that tongue‑tie can significantly affect feeding and that frenotomy is safe, effective, and results in better outcomes for both mother and infant compared with intensive lactation support alone.
Systematic Reviews and Long‑Term Outcomes
Does frenotomy improve breastfeeding difficulties?
Across reviewed outcomes, frenotomy demonstrated consistent positive effects on breastfeeding. The overall quality of evidence was rated as moderate, with no major complications reported.
Lingual frenotomy for breastfeeding difficulties: Prospective follow‑up study
Favourable long‑term breastfeeding outcomes were reported following frenotomy. While not all difficulties resolved, worsening was rare, and the procedure was considered a useful adjunct to breastfeeding support.
Do tongue ties affect breastfeeding?
Following division, 80% of infants fed better within 24 hours, and 64% continued breastfeeding beyond three months, significantly exceeding national averages. No significant complications were reported.
Timing and Safety
Tongue‑Tie Assessment and Division: A Time‑Critical Intervention
Delay beyond four weeks from referral to assessment was associated with increased breastfeeding cessation. Timely assessment and intervention can play a significant role in breastfeeding success.
Short‑ and long‑term outcomes following frenotomy
Large cohort data demonstrate high rates of improvement in feeding and functional symptoms, with low rates of minor, transient adverse effects.
Beyond Breastfeeding: Speech, Sleep, and Orofacial Function
Speech outcomes
Systematic reviews suggest objective and subjective benefits of frenotomy for breastfeeding, while evidence linking ankyloglossia directly to speech articulation difficulties remains limited, highlighting an area for further research.
Sleep‑disordered breathing
Emerging evidence suggests a short lingual frenulum may contribute to oral dysfunction, craniofacial development, and increased risk of sleep‑disordered breathing in children.
Myofunctional therapy and multidisciplinary care
High‑level evidence supports the role of orofacial myofunctional therapy in improving oral function, breathing, swallowing, and sleep‑related symptoms. Studies exploring combined frenuloplasty and myofunctional therapy protocols demonstrate promising safety and efficacy in appropriately selected patients.
Clinical Guidelines and Consensus
• American Academy of Breastfeeding Medicine (2016). Protocol #11: Evaluation and management of neonatal ankyloglossia
• Coryllos, Genna & Salloum (2004). Congenital tongue‑tie and its impact on breastfeeding
• Cochrane Reviews examining frenotomy, oral stimulation, and myofunctional interventions
Ongoing Research and Trends
Systematic reviews and population‑based studies demonstrate a significant increase in tongue‑tie diagnosis and frenotomy worldwide over recent decades. Current research continues to explore optimal assessment tools, timing of intervention, multidisciplinary care models, and long‑term functional outcomes.
Tongue Tie Galway remains committed to evidence‑informed practice and will continue to update this page as new high‑quality research becomes available.
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Reference List: Ankyloglossia / Tethered Oral Tissues
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Agarwal, R., Eddis-Finbow, M., Tam, J., Broatch, J., & Bussey, K. J. (2024). New validated tool to diagnose breastfeeding dysfunction. Journal of Human Lactation, 40(1), 120–131. https://doi.org/10.1177/08903344231209306
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Aguiar, L. S., Juliano, G. R., Silveira, L., Oliveira, M. S., Torquato, B., Araújo, M. F., Pereira, S., Teixeira, V., & Ferraz, M. (2018). Tongue development in stillborns autopsied at different gestational ages. Jornal de Pediatria, 94(6), 616–623. https://doi.org/10.1016/j.jped.2017.08.009
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Ai, G., Cai, B., Zhou, L., Zhu, D., & Wu, X. (2025). Prenatal ultrasonic features of median cleft of the lower lip and mandible with ankyloglossia. Journal of Clinical Ultrasound. https://doi.org/10.1002/jcu.24042
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Alan, A., Orhan, A. I., & Orhan, K. (2024). Evaluation of breastfeeding dynamics of neonates with ankyloglossia using ultrasonography. Diagnostics, 14(6), 608. https://doi.org/10.3390/diagnostics14060608
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American Academy of Breastfeeding Medicine. (2016). Protocol #11: Guidelines for the evaluation and management of neonatal ankyloglossia. https://www.bfmed.org
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Arena, M., Micarelli, A., Guzzo, F., et al. (2022). Outcomes of tongue-tie release using assessment tools: A scoping review. Acta Otorhinolaryngologica Italica, 42(6), 492–501. https://doi.org/10.14639/0392-100X-N2211
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Ariestiana, Y. Y., Gazali, M., & Basyar, H. (2024). Effectiveness of frenuloplasty on speech quality. Open Access Macedonian Journal of Medical Sciences, 12(1), 12–21. https://doi.org/10.3889/oamjms.2024.960
Baxter, R., Merkel-Walsh, R., Baxter, B. S., Lashley, A., & Rendell, N. R. (2020). Functional improvements after lingual frenectomy. Clinical Pediatrics, 59(9–10), 885–892. https://doi.org/10.1177/0009922820928055
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Baxter, R., & Merkel-Walsh, R. (2025). Cerebral palsy and ankyloglossia: A case series. Special Care in Dentistry, 45(3), e70046. https://doi.org/10.1111/scd.70046
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Becker, S., & Mendez, M. D. (2022). Ankyloglossia. In StatPearls. StatPearls Publishing.
Bellieni, C. V., et al. (2024). Ankyloglossia in newborns: Incidence and breastfeeding follow-up. Minerva Pediatrics. https://doi.org/10.23736/S2724-5276.23.07357-3
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Benoiton, L., Morgan, M., & Baguley, K. (2016). Management of posterior ankyloglossia. International Journal of Pediatric Otorhinolaryngology, 88, 13–16. https://doi.org/10.1016/j.ijporl.2016.06.037
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Braybrook, C., et al. (2001). Identification of KLHL4 gene related to cleft palate and ankyloglossia. Genomics, 72(2), 128–136. https://doi.org/10.1006/geno.2000.6478
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Browne, D. (1959). Tongue-tie. British Medical Journal, 2, 1181–1182.
Camacho, M., et al. (2017). Tongue surgeries for pediatric obstructive sleep apnea. European Archives of Oto-Rhino-Laryngology, 274(8), 2981–2990. https://doi.org/10.1007/s00405-017-4545-4
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Carnino, J. M., et al. (2024). Speech outcomes of frenectomy: A meta-analysis. Annals of Otology, Rhinology & Laryngology. https://doi.org/10.1177/00034894241236234
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Chinnadurai, S., et al. (2015). Treatment of ankyloglossia beyond breastfeeding. Pediatrics, 135(6), e1467–e1474. https://doi.org/10.1542/peds.20150660
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Corrêa, C. C., et al. (2022). Prevalence of ankyloglossia by assessment tools: Meta-analysis. Journal of the American Dental Association, 153(11), 1026–1040.e31. https://doi.org/10.1016/j.adaj.2022.07.011
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Coryllos, E., Genna, C. W., & Salloum, A. C. (2004). Congenital tongue-tie and breastfeeding. American Academy of Pediatrics.
Daggumati, S., et al. (2019). Speech outcomes after frenulectomy. OTO Open, 3(1). https://doi.org/10.1177/2473974X19826943
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de Castro Martinelli, R. L., Marchesan, I. Q., & Berretin-Felix, G. (2012). Lingual frenulum protocol for infants. International Journal of Orofacial Myology, 38, 104–113.
Hazelbaker, A. (2010). Tongue-tie: Morphogenesis, impact, assessment and treatment. Aidan and Eva Press.
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Hogan, M., Westcott, C., & Griffiths, M. (2005). Randomized controlled trial of tongue-tie division. Journal of Paediatrics and Child Health, 41(5–6), 246–250. https://doi.org/10.1111/j.1440-1754.2005.00604.x
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Ingram, J., et al. (2015). Development of a tongue assessment tool. Archives of Disease in Childhood Fetal and Neonatal Edition, 100(4), F344–F348. https://doi.org/10.1136/archdischild-2014-307503
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Kotlow, L. A. (2013). Diagnosing maxillary lip-tie and breastfeeding. Journal of Human Lactation, 29(4), 458–464. https://doi.org/10.1177/0890334413491325
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Marchesan, I. Q. (2004). Lingual frenulum classification and speech interference. International Journal of Orofacial Myology, 30(1), 32–39.
Messner, A. H., & Lalakea, M. L. (2000). Ankyloglossia controversies. International Journal of Pediatric Otorhinolaryngology, 54(2–3), 123–131. https://doi.org/10.1016/S0165-5876(00)00359-1
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Messner, A. H., et al. (2020). Clinical consensus statement: Ankyloglossia in children. Otolaryngology–Head and Neck Surgery. https://doi.org/10.1177/0194599820915457
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Mills, N., Geddes, D. T., & Mirjalili, S. A. (2019). Defining the anatomy of the lingual frenulum. Clinical Anatomy, 32(6), 749–761. https://doi.org/10.1002/ca.23343
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O'Callahan, C., Macary, S., & Clemente, S. (2013). Office-based frenotomy effects on breastfeeding. International Journal of Pediatric Otorhinolaryngology, 77(5), 827–832. https://doi.org/10.1016/j.ijporl.2013.02.022