A tongue tie doesn’t always look like a dental problem. But if the tissue under the tongue is short enough to hold it down, it can change where the tongue rests, how you swallow, whether you breathe through your nose, and over time, how your jaw and bite develop.
When a tie really is getting in the way, releasing it can help a lot. What most people don’t expect is that the release is just the beginning.
What a tongue tie actually is
Most people picture a tongue tie as a little string under the tongue. It isn’t really a string. When researchers dissected it, they found the tissue under the tongue is a fold of fascia, the thin connective tissue that wraps around and connects muscles, covered by the lining of the mouth. A tight tongue tie is that fascia holding on when it should have loosened.
That’s how such a small piece of tissue can cause so many problems. The main muscle of the tongue hangs from that layer of fascia along the floor of the mouth. So when it’s tight, it isn’t just tying down the tip. It’s holding back the whole tongue, which changes where it rests, how you swallow and how you breathe.
Fascia doesn’t stop at the mouth, either. The fascia under the tongue is part of the same connected web that runs through the rest of the body, and those connections carry all the way down to the feet. Anatomy studies have confirmed several of these fascial chains, including one that runs from the head down the back of the body to the soles of the feet. That’s one reason a tight tongue so often shows up alongside tension in other parts of the body.
What researchers haven’t measured yet is how much a tight spot under the tongue actually pulls on the rest of those chains. So we’d put it this way: the tongue is connected to everything else, and exactly how much a tongue tie affects the rest of the body is still being worked out.
Mills N et al. Defining the anatomy of the neonatal lingual frenulum. Clin Anat. 2019;32(6):824-835. Wilke J et al. What is evidence-based about myofascial chains: a systematic review. Arch Phys Med Rehabil. 2016;97(3):454-461. That review confirmed several chains through dissection, including the one running down the back of the body to the feet; how much tension actually travels along them is still being studied.
“Why don’t you just release it?”
We hear this all the time, and it’s a good question. Releasing a tongue tie frees the tongue up. It doesn’t teach the tongue where to go.
A few things can happen when a tongue is released and left alone. As the area heals, the tissue can scar back down and tie the tongue again. That’s one of the most common problems reported after a release.
The other thing we see is the tongue falling further back. If your tongue has spent years sitting low in your mouth, it has never learned to rest up against the roof of your mouth. Once it’s free, it doesn’t just find the right spot on its own, and it can end up sitting even lower and further back than it did before.
That’s why we pair a release with training. The tongue has to learn where it’s supposed to go, and that’s what keeps the release working.
The training is myofunctional therapy: exercises for where the tongue rests, how you swallow, keeping your lips together and breathing through your nose. Dr. Lee-Mirzayan is a dentist and a certified myofunctional therapist, and she does the releases herself. Because one person is handling both, the release and the therapy get planned together from the start.
How long it takes
Usually about 6 to 8 weeks of myofunctional therapy before the release, and about 8 weeks after it.
The weeks before get the tongue stronger and used to where it should sit, so it’s ready by the time it’s released. The weeks after are what keep it from settling back where it was while everything heals.
What the research says
There isn’t a lot of good research on tongue ties yet, but what’s out there lines up with how we do it.
When pediatric ear, nose and throat surgeons were surveyed across the country, 60% said they’d seen a complication after a tongue-tie release, and reattachment was one of the two they saw most often.
A 2024 randomized trial of 155 children and adults compared myofunctional therapy on its own with therapy plus a release. The group that had both did significantly better with tongue movement, swallowing, breathing and where the tongue rested.
A 2022 review of the studies found that surgery worked better than therapy alone, and that combining the two worked best, though the authors pointed out there weren’t many studies and most weren’t high quality. A 2023 review found that many studies recommend tongue exercises both before a release and in the weeks after.
Dhir S et al. Survey of pediatric otolaryngology frenotomy practice patterns. Laryngoscope. 2022;132(12):2505-2512. Lichnowska A et al. A prospective randomized control trial of lingual frenuloplasty with myofunctional therapy in patients with maxillofacial deformity. J Clin Med. 2024;13(18):5354. Gonzalez Garrido MDP et al. Effectiveness of myofunctional therapy in ankyloglossia: a systematic review. Int J Environ Res Public Health. 2022;19(19):12347. Frezza A et al. Treatment of ankyloglossia: a review. Children (Basel). 2023;10(11):1808. None of these studies compared a release on its own with a release plus training. What we’ve said about the tongue settling further back comes from our own experience with patients.
Not every tongue tie needs to be released
Lots of people have a tongue tie you can see that isn’t actually causing any trouble. Whether yours matters depends on what we find at the exam: how far your tongue moves, where it sits at rest, how you swallow and breathe, and what else is going on. If a release isn’t going to make a difference for you, we’ll tell you.
How the release is done
Dr. Lee-Mirzayan does tongue-tie releases for kids and adults. She uses our LightScalpel CO2 laser, which cuts and seals the tissue at the same time, so the procedure is precise and bleeding is kept to a minimum.
The tongue training helps with the procedure itself, too. Once you’ve learned to suction your tongue up against the roof of your mouth, the blood vessels and other structures underneath are pulled up and out of the way, which makes for a cleaner release. That matters, because small branches of the nerve that supplies the tongue run just beneath that layer of fascia.
It is still surgery, so there can be some bleeding if a blood vessel gets nicked. Most people are sore for the first couple of days, and over-the-counter pain relievers are usually all that’s needed.
We use the same laser for other small soft tissue procedures too, so you don’t have to be sent somewhere else for those.
Wondering if this is part of your plan?
If you’ve been told you have a tongue tie, or you think one might be behind your breathing, swallowing or jaw tension, tell us what’s going on or call 702-734-0776. We’ll help you figure out whether a release, therapy or both makes sense for you.
General education, and not a substitute for an exam.