Posterior Tongue Tie – Causes, Symptoms and Treatment

Posterior tongue tie (ankyloglossia) is a shortening of the frenulum of tongue, thereby limiting his mobility. The shortening of the bridle – a birth defect. Newborn posterior tongue tie causes disturbances in the process of sucking. In older children it can be a malocclusion, speech defects and problems with swallowing.

There are four types of posterior tongue tie:

  1. In the first type of posterior tongue tie the frenulum is short and thin and does not contain large vessels.
  2. In the second type of posterior tongue tie bridle short and thick, with a content of large blood vessels and connective tissue.
  3. while the posterior tongue-tie is characterized by the thickening brake (type III)
  4. or a submucosal brake (a wide, flat mound lingual ) which restricts movement to the base of the tongue (type IV).

The classification of braces by Dr. Elizabeth and Catherine Watson Genna Coryllos also allows us to have a global rating scale that gives us understanding.

Posterior Tongue Tie type 1 above:

Frenulum insertion occurs at the tip of the tongue. When the baby cries, tongue or heart-shaped appears bifida, as the bridle pulls the tip of his tongue into her mouth.

Posterior Tongue Tie type 2 above:

The insertion occurs bridle few millimeters further back than type 1. The language is not usually see bifida, but when the baby cries, you can see the tip of the tongue falls down.

Posterior Tongue Tie type 3 Rear:

This type of bridle could be defined as a combination of types 2 and 4, since there is little visible membrane at the back of the tongue but also a submucosal anchor, so not enough to sever the membrane to release the tongue floor of the mouth.This type of bridle may be difficult to observe with the naked eye, but just spend a finger from side to side under the tongue resting baby to notice him. 

The tongue may have a normal appearance and perform extension movements with relative ease, but doing so will warp the periphery and become depressed in the center, and the baby can not raise it to touch the palate with mouth wide open. Depending on the thickness and woodiness of the submucosal component, the tongue may also present a matted and compact appearance.

Posterior Tongue Tie Type 4 bridle later:

Bridle as such is not seen with the naked eye because it is hidden under a layer of mucosal tissue, and almost totally restricted mobility of the tongue, so it is very anchored to the floor of the mouth and can present a compact appearance.The movement of the tongue is usually asymmetric. Often a pointed or narrow palate, a direct consequence of the low mobility of the tongue is appreciated.

Ankyloglossia literally means “tongue tied or anchored” and is a very graphic definition of what happens to babies born with frenulum too short for the tongue: the tongue is attached to the floor of the mouth and can not perform the necessary movements for the baby to suck effectively without compromising the welfare of his mother.

Symptoms of Posterior Tongue Tie

Ankyloglossia, or posterior tongue tie, has has been said congenital, which is detected after the inspection frenum. Among the symptoms of posterior tongue tie are sucking and swallowing problems, speech difficulties, mechanical problems and mandibular growth:

  • Sucking and swallowing (13%): the tie occurs in approximately 5% of newborns (8). This alteration is associated with 25-60% of the incidence of difficulties during breastfeeding for both mother and infant. Thus, you may have damage to the mother’s nipple, breast pain caused by extreme exertion suction, repeated episodes of mastitis, recuso breastfeeding, neonatal dehydration, poor milk supplement for infant causing poor weight gain and premature weaning may prevent the development of adult swallowing mechanism (8,10,12,13,14,20,21,22). These findings suggest that neonatal frenectomy should be considered in this select group of mothers whose infants with posterior tongue tie are also having trouble breastfeeding (8).
  • Speech (32%): the speech problem related to the tie is often overestimated. Sometimes, it can cause errors in the joint and affect the expression of alveolar-lingual and dental-lingual as t, d, l, n and r consonants; because the pronunciation of these requires opposition of the tongue against the socket or palate (22). Most joint failures has been found in people with limited mobility of the tongue when compared to those with normal mobility. Moreover, there is sufficient evidence that a good speech is still possible in the presence of a significant ankyloglossia and speech problems can be overcome without frenectomy, and yes with a speech therapy (10).
  • Mechanical Problems (14%): these are the most underrated problems of posterior tongue tie. The lack of mobility of the tongue causes inability to perform an internal oral self-cleaning, disabled lick lips and prevents often play wind instruments (9), implying social problems.
  • Mandibular growth: mild ankyloglossia no effect on the growth of the jaw except minor dental abnormalities of the incisors or mucogingival recession. The tie may cause more severe and other prognatismo open cases (10,22,23) bite.
  • Retrognathia: although the retrognathia (shorter lower jaw from the top) is physiological in infants and changes with growth, babies with posterior tongue tie usually have an obvious retrognathia.
  • Lingual corn: the corn or callus, tongue indicate that the baby must pull hard to grab the chest and that it causes sores by rubbing.
  • Irregular movements of the language: when the baby cries we can see that the language does not move symmetrically, stands or bends of different areas
  • Clicks: babies with posterior tongue tie can suck making noises with his tongue clicks, very characteristic indicating that occasionally the tongue can not maintain grip.
  • Arched palate: the language, at rest, can not be placed in the correct position it just modifying oral structures. The upper jaw is narrow forming a V, and palate sinks in parallel, which gives a deep look.

Many children with the disease symptoms are not manifested. As children get older lingual frenulum becomes longer and corresponds arisen as a result of disease restrictions in the movement of the tongue. But some children with this disease experience the following symptoms:

  • Low self-esteem and difficulties with adaptation. Child with posterior Ankyloglossia is unable to play wind instruments or using the language clean the teeth from food. Often it causes ridicule from the other guys.
  • Speech defects occur because the tip of the tongue can not rise to the desired level, so the child is not able to pronounce certain letters: l, n, s, s, d, t.
  • Difficulties with nutrition in infancy, because the child is loosely adjacent to the mother’s breast. The solution in such a situation becomes artificial nutrition.

Causes of Posterior Tongue Tie

This is a congenital defect, it is inherited. As a rule, these problems had parents or someone of the other next of kin. In the development of children with this defect often additional anomalies were observed. Normally tongue-tied observed in children whose mothers during pregnancy used cocaine. 

In addition, the disease occurs in people who are diagnosed with a congenital defect, causing deformation of the face and the oral cavity. For example, it may be cleft palate, which is directly related to changes in the X-chromosome.

The prevalence of short bridle of tongue occurs three times more often in boys than in girls. Up to 50% of patients with Ankyloglossia have close relatives with the same pathology. Most of the children otherwise relatively healthy, but in some it can be a manifestation of the syndrome of multiple congenital malformations. Ankyloglossia prevalence is approximately 1: 1000.

My Baby Is Tongue Tied, Do I Need To Worry?

For any new parent, the thought of anything being wrong with their sweet little bundle of joy is scary. Fortunately, in most cases, a tongue tied baby is nothing to be overly concerned about. Posterior tongue tie, also known as ankyloglossia, is a condition in which the piece of tissue which connects the tongue to the floor of the mouth (the frenulum) is unusually shorter in length than what would typically be seen.

For older kids and adults, this may result in restricted speech, which may require speech therapy. The phrase “to be tongue tied,” refers to a person who is unable to speak in public, or may stammer when doing so. Fortunately, for most people, this condition does not cause any great issues with speech or ability to eat and swallow, however, depending upon severity, it may require medical intervention in the form of a surgical procedure.

Complications of Posterior Tongue Tie

Frenulum can affect the baby’s development, as well as the way they eat or speak.

Tongue tie is too short hazards

1, limiting the activities of the tongue in the mouth, affecting articulation and pronunciation, especially retroflex, palatal retroflex sound and greater impact, such as the Chinese phonetic alphabet “L” English letters “R”, and to eat “eat” pronunciation difficulties. Restricted tongue movement also have an impact on chewing.

2, when the infant sucking, because the posterior tongue tie is too short, often by two lower front teeth friction occurs ulcer .

For example, can lead to:

Problems of breastfeeding. If a child is not able to move or retain the tongue in the right position, could chew instead of sucking. This can cause pain to the mother and interfere with the child’s ability to receive breast milk. Ultimately, it can lead to malnutrition and growth retardation.

Difficulty speaking. It can interfere with the ability to emit certain sounds such as “t”, “d”, “z”, “s” and “r”.

Poor oral hygiene. For a child or an adult, the condition can complicate oral hygiene, and make it difficult to wipe food debris from the teeth. This can contribute to tooth decay and gum inflammation ( gingivitis ). It can also lead to the formation of a vacuum between the two front bottom teeth (lower central incisors).


Frenulum is usually diagnosed during a physical exam. For children, the doctor may use a light to control various aspects of the language and the ability to move.

In most cases, the diagnosis of congenital allows inspection of cavity growth of the child, as well as relevant symptoms. On examination, the doctor lifts the baby’s tongue and checks whether the normal length of the lingual frenulum, whether it is close adjacent to the tip of the tongue. If the specialist examines an older child or an adult, they take into account the movement of the language and its form, when the tongue protruding from the mouth.

Treatments and cures of Posterior Tongue Tie

The treatment is controversial. Some doctors and lactation consultants recommend to correct the problem immediately, even before the baby is discharged from hospital. Others prefer to wait.

Sometimes the lingual frenulum is loosened in the course of time and the condition resolves itself.In other cases, but it persists without causing problems.

If the ankyloglossia interfere with breastfeeding, it can be treated with a simple surgical procedure called frenulotomy. For older children and adults who have difficulty with this condition, the larger procedure known as frenuloplasty it could be recommended.

In most cases, the diagnosis of congenital allows inspection of cavity growth of the child, as well as relevant symptoms. On examination, the doctor lifts the baby’s tongue and checks whether the normal length of the lingual frenulum, whether it is close adjacent to the tip of the tongue. If the specialist examines an older child or an adult, they take into account the movement of the language and its form, when the tongue protruding from the mouth.

Surgical treatment of Posterior Tongue Tie in children


The frenulotomy can be done with or without anesthesia in the hospital or at the doctor’s surgery.

During the procedure, the doctor will examine the lingual frenulum and then use sterile scissors to cut it. The procedure is fast, and the discomfort is minimal as there are few nerve endings or blood vessels of the lingual frenulum.

Bleeding is often small. After the procedure, the child can breastfeed even immediately.

Frenulotomy complications are rare but may include bleeding, infection, or damage to the salivary glands and tongue. It ‘also possible that the frenulum is paid is at the base of the tongue.

Surgical treatment for older children or adults

The frenuloplasty is performed under general anesthesia with surgical instruments. After the frenulum is cut, the wound is closed with sutures usually are absorbed when the tongue heals.

Complications of frenuloplasty are similar to those of frenulotomy or bleeding, infection or damage to the salivary glands / language. The presence of scars is possible because of the broader nature of the procedure.

After frenuloplasty, language exercises may be recommended to improve the movement of the tongue and reduce the risk of scarring.

How Posterior Tongue Tie Surgery Is Done

When indicated, neonatal frenectomy (He cut the bridle without repair) is a simple procedure that can be performed in the office at the beginning of the consultation 14. In children older than 4 months, anesthesia is usually required because of the resistance and sensitivity of the infant.

However, before this age the procedure can be performed without anesthesia with minimal discomfort to the baby. The tongue is lifted gently with a grooved retractor to expose the frenulum, which is cut with a fine scissors approximately 2-3 mm at its thinnest portion between the tongue and the alveolar process.

The postoperative period.

After the operation the baby can lick your lips, tongue stick out. Often there is an improvement in appetite. After surgery significantly improves the child’s speech, but it does not always occur immediately. You may need some time to wait. If it were implemented later frenotomy language, the child will have to re-learn correct pronunciation of sounds.

Correction of Speech in Posterior Tongue Tie

Need to understand that not had surgery, it must be accurate pronunciation, there are some tongue-tie is too short who despite surgery, articulate remains unclear, after their training is very important.

Since the completion of the human language is a very complex process, relying on the brain and central nervous system, oral cavity, nasal cavity, and many other organs together. The main tongue lisp general tone volume sounds vague tongue and palate, we should strengthen this aspect of voice training, which might play a multiplier effect.

Third, the child pronunciation, routine prevention to do:

  1. to give the child to create a good language learning environment for children more contact with children the same age, because learning and communication easier among children.
  2. when teaching children to learn to speak mainly in kind, so that the child would be interested, memories will be more profound, and the process of teaching children to be more to ask questions, because questions can stimulate the child’s brain, promote language features development.
  3. do not guess the child’s desire to replace the children to speak, but to guide him to speak out, for example, he wants to refer to something by hand, you can pretend not to understand, and guide him to express, if you really do not say, You can say a word, the rest of the children to supplement.
  4. parents should play the role of a role model, imitation is the main way children learn to speak, so parents when their children tend to speak slower, lighter tone, articulation should be clear, let the children hear every one of your hair tone.
  5. do not rebuke and scold the child in the process of educating the children, and do not forcing him to say, to be more praise and encourage him, slowly, he can learn to speak.

in children with tongue-tie can cause problems with the pronunciation of the letters “d”, “n”, “n” and “m”. Often parents bring them to a speech therapist at the age of four years and they can be difficult to re-learn how to pronounce the sounds correctly, even after surgery frenotomy.

Therefore, late surgical correction at ankyloglossia ineffective. Just before surgery can prevent the development of speech, speech problems. In the past, midwives ripped truncated bridle sharp fingernail. Nowadays treatment depends on the child’s age, severity of disease and the availability of a split tip of the tongue.


In conclusion, the posterior tongue tie should be considered in children with breastfeeding difficulties and speech. Obviously there is no consensus on the diagnosis and management of this condition. Based on the available literature we frenectomy consider a proposal for safe, effective and practical treatment in the management of patients with ankyloglossia related to these problems. However, along with the pediatric dentist or dental surgeon audiologist must assess some effects on the function of language before deciding for a conservative or surgical treatment.