Posterior Tongue Tie: Complications and Treatment Options

Tongue-tie is another name for a condition called ankyloglossia. To understand what it means, let’s quickly talk about the anatomy of the tongue: 

• The anterior tongue is the front two-thirds of the tongue.
• The posterior tongue sits near the back of the throat and makes up the other third.
• The lingual frenulum is the web of tissue under your tongue that connects it to the floor of your mouth.

Tongue-tie happens when your newborn's frenulum is abnormal and restricts the movement of their tongue. If it's in the front two-thirds of the tongue, it's anterior tongue-tie. If the condition is in the back third, it's posterior tongue-tie.

According to the Mayo Clinic, tongue-tie can affect anyone but is more common in boys than in girls, and it can also run in the family.

Anterior tongue-ties are easier to diagnose because the tissue connecting the anterior tongue to the floor of your child's mouth is visible. Posterior tongue-ties, however, aren't as noticeable and can be tricky to detect in a newborn. Some signs your infant may have this condition include:

• Difficulty breastfeeding.
• Inability to stick their tongue out past their teeth (their tongue may appear notched or heart-shaped when they try to do so).
• Inability to lift their tongue or move it side to side.
• Not licking their lips or sweeping food from their teeth.
• Failure to gain weight and grow as expected.
• A clicking sound when feeding.
• Restricted opening of the mouth.
• A receding lower jaw.
• Excessive reflux.
• Colic.

If you think your newborn may have tongue-tie, speak with your healthcare professional. Difficulty breastfeeding can prevent your child from getting the important nutrients they need. Without treatment, a tongue-tie can cause problems later in life, too. Having limited tongue movement can make speech more challenging. A tongue-tie can also increase a person's risk of tooth decay and other oral hygiene issues.

The treatment your healthcare professional will recommend depends on the severity of your child's condition. It's possible for some cases of posterior tongue-tie to eventually loosen up and relax on their own. According to Johns Hopkins Medicine, if breastfeeding is the only concern, your doctor may recommend the aid of a lactation consultant or infant feeding expert to see if the situation can be resolved without your child needing surgery.

But some doctors prefer to prevent any possible eating or speech issues that may develop in the future by performing surgery right away. The two most common procedures for tongue-ties are:

• Frenotomy. Sterile scissors are used to make a small cut in the frenulum, allowing your child's tongue to move more freely.
• Frenuloplasty. This more extensive procedure may be recommended if your child's frenulum is too thick for a frenotomy. During this procedure, your child would undergo general anesthesia while the surgeon uses surgical tools to release the frenulum. They then use sutures to repair the incision. Speech therapy and tongue exercises may be part of the recovery process.

These are relatively simple procedures, and, in general, they're safe, too. But like any surgery, there are potential risks that are important to look out for, like:

• Severe bleeding.
• Infection.
• Injury to the salivary ducts.
• Breathing difficulties or trouble breathing..

If you notice any symptoms or side effects that concern you after your child's procedure, contact your healthcare professional right away.