Tethered Oral Tissues

Tethered Oral Tissues

TOTs (Tethered Oral Tissues) includes restriction of the lingual frenum also known as ankyloglossia, but can also be a restriction of the frena of the lips and cheeks, by a band of tissue. There are seven frena in the oral cavity that can be impacted by TOTs.

Tongue-tie is a birth defect that occurs when the strip of skin (lingual frenum) that connects a baby’s tongue to the floor of the mouth restricts the movement of the tongue. Typically, this strip of skin separates before birth, which allows the tongue free range of motion.

Tongue-tie is a common condition that, if assessed and addressed quickly, will not hinder a child’s development. If left untreated, however, tongue-tie can result in other conditions including malnourishment, speech difficulty, or poor oral hygiene.


  • Restriction of the tongue’s movement, making it harder to breastfeed
  • Difficulty lifting the tongue up or moving it from side to side
  • Difficulty sticking the tongue out
  • The tongue looks notched or heart-shaped when stuck out


The treatment of tongue-tie for infants is a simple surgical procedure called a frenectomy. The releasing surgeon examines the lingual frenulum, then uses sterile scissors or a laser to release the tissue, freeing the tongue to allow a fuller range of function.

Stitches are usually not necessary when using a laser. Since there are few nerve endings or blood vessels in the lingual frenulum, only a local anesthetic is used.
Frenectomy for tongue-tie in older children and adults is similar to that for infants, although compliance with therapy tends to be a bit more difficult. Myofunctional therapy and speech therapy before and after surgery are necessary for successful outcomes.