Perspective from Adva Buzi, MD
July 23, 2019
3 min read

Tongue-tie surgery unnecessary for about 60% of infants

Perspective from Adva Buzi, MD
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More than half of infants referred to an otolaryngology center for tongue-tie surgery did not need to undergo the procedure after consultation with a speech-language pathologist, according to recent findings.

Tongue-tie, or ankyloglossia, is characterized by the lingual frenulum attaching close to the tip of the tongue. Researchers suggest that between 4% and 11% of all newborns have this condition, which can cause problems breastfeeding. An analysis of the Kids’ Inpatient Database showed that tongue-tie surgeries increased 10-fold in the United States between 1997 and 2012, but inadequate evidence supports that this surgery improves the ease of breastfeeding.

“We have seen the number of tongue-tie and upper lip tether release surgeries increase dramatically nationwide without any real strong data to show these are effective for breastfeeding,” study author Christopher J. Hartnick, MD, MS, director of the division of pediatric otolaryngology and the Pediatric Airway, Voice and Swallowing Center at Massachusetts Eye and Ear Infirmary, said in a press release. “We don’t have a crystal ball that can tell us which infants might benefit most from the tongue tie or upper lip release, but this preliminary study provides concrete evidence that this pathway of a multidisciplinary feeding evaluation is helping prevent babies from getting this procedure.”

Photo of mother breastfeeding her infant 
Source: Adobe Stock

The researchers conducted an observational quality improvement study that included 115 infants and their mothers. All infant-mother pairs were referred for feeding evaluation between March and December 2018 because of difficulties with breastfeeding. The evaluation was led by speech-language pathologists.

Surgery was unneeded for 62.6% of referred infants after consultation with a speech-language pathologist. When surgery was needed, 8.7% required labial frenotomy only, and 27.8% had both labial and lingual frenotomy.

“We’ve learned that an interdisciplinary collaboration is key to a thorough feeding evaluation,” Cheryl Hersh, MS, CCC-SLP, a pediatric speech-language pathologist at MassGeneral Hospital for Children, said in the release. “This is still a work in progress, but we have learned a great deal about what we can do differently to help our patients and their families. In doing so, we have been able to identify many babies who are having breastfeeding problems that are not related to their lip and tongue anatomy.” – by Katherine Bortz


Caloway C, et al. JAMA Otolaryngol Head Neck Surg. 2019;doi:10.1001/jamaoto.2019.1696.

O’Shea JE, et al. Cochrane Database Syst Rev. 2017;doi:10.1002/14651858.CD011065.pub2.

Walsh J, et al. Otolaryngol Head Neck Surg. 2017;doi:10.1177/0194599817690135.

Disclosures: Hersh reports receiving a salary from the Massachusetts General Hospital. All other authors report no relevant financial disclosures.