Tongue-tie refers to the small band of tissue under your tongue, called the lingual frenulum, when it is too short. This limits how well your tongue moves and can cause various issues from speech to sleep.
People with tongue-tie often have trouble lifting their tongue up, sticking it out forward, or moving it side to side. These limitations can impact the way you breathe, chew, swallow, and even hold tension in your jaw and neck.
When your tongue cannot move freely, it tends to rest low in your mouth. During sleep, it can fall backward and block your throat. This is connected to Obstructive Sleep Apnea (OSA), a dangerous condition where your airway repeatedly collapses during sleep.
However, new research shows that fixing a tongue-tie in adults can improve these symptoms. This surgery is called a Frenectomy.
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What To Expect During a Frenectomy
A frenectomy releases the tight string (frenum) under the tongue. When tongue-tie is present, the tongue cannot reach the roof of the mouth and instead falls into the back of the throat, which contributes to airway blockage. After the procedure, the tongue can return to a normal resting position.
Modern medicine has made this surgery very quick and easy for adults.
- The Procedure: Most doctors now use a laser. The laser “zaps” the tight tissue away. It is very precise and usually takes less than 15 minutes. Other doctors may use a scalpel; both approaches work by removing the tissue under the tongue.
- Pain Control: You will receive a local numbing shot, similar to what you would get at the dentist, so you won’t feel anything during the snip.
- Healing: Because lasers are used, there is usually very little bleeding and often no need for stitches. Most adults find they can go back to work or daily activities the very next day.
The genioglossus is the muscle that helps keep the upper airway open. It holds your tongue forward and up, keeping your throat open while you sleep. When tongue-tie limits how far your tongue can move, this muscle never gets to do its full job.
Releasing the frenulum gives it room to finally work the way it was designed to.
Before Your Frenectomy Appointment
Before suggesting removal, your provider will check how restricted your tongue is. One common tool measures the ratio between how wide you can open your mouth and how high your tongue can reach when you lift it.
This is called the Tongue Range of Motion Ratio (TRMR) and is graded from 1 (minimal restriction) to 4 (severe restriction).
Before surgery, you will be asked to start doing tongue exercises. Practicing for about one month before your procedure helps you get familiar with the movements and makes the post-surgery exercises much easier to do correctly.
Managing Discomfort And Pain After Frenectomy
The procedure itself should be painless, but you are still healing a wound in a sensitive area.
For the first day or two, you may feel a sore throat sensation or mild aching under the tongue. Over-the-counter pain medicine is usually enough.
Rinsing with warm salt water helps keep the area clean without irritating it, but always ask your doctor beforehand.
The most important part of recovery is moving your tongue regularly.
Doing tongue stretches after surgery helps prevent the wound from closing back down with scar tissue and supports proper healing. Even though it may be a little uncomfortable at first, keeping up with these exercises is essential.
The Power of Tongue Exercises (Myofunctional Therapy)
One of the biggest discoveries in recent studies is that surgery alone is not enough. Because your tongue has been tied your whole life, the muscles are often weak or untrained.
To get the best results, your doctor will likely suggest you combine surgery with Myofunctional Therapy.
This is a series of exercises that teach your tongue how to move in its new, free space.
These exercises focus on improving the coordination, strength, and endurance of the tongue, throat, and facial muscles. Stronger, better-coordinated muscles help keep the airway open and can reduce the severity of sleep apnea.
The exercises used in clinical research include three done three times a day:
- Palate scrapes: Press your tongue tip to the front of the roof of your mouth, then drag it slowly backward and hold for 5 seconds. Repeat 5 times.
- Elephant swing: Stick your tongue out as far as you can, then sweep it left and right to the corners of your lips. Repeat 5 times.
- Tongue clicks: Suction your tongue up against the roof of your mouth, then release it with a clicking sound. Repeat 5 times.
In research, patients who did both the surgery and the exercises had much better results than those who only did the surgery. It was said to improve “…tongue strength, quality of life, and symptoms associated with OSA and ankyloglossia….”
Before surgery, expect to do these exercises for about 4 to 6 weeks. After surgery, you continue them to prevent scarring and to build strength in your newly released tongue.
The Benefits of Adult Frenectomy + Exercises
When researchers looked at adults who had this procedure, they found three major improvements:
- Better Sleep: Studies using the “Epworth Sleepiness Scale” (a tool to measure how tired you feel) showed that patients felt a modest improvement during the day after treatment.
- Easier speaking and swallowing: In adults, a frenectomy has been shown to improve both speech and swallowing, which can be affected by a restricted frenulum at any age.
- Improved Airway: For people with mild sleep apnea, the surgery helped reduce snoring and improve oxygen levels during the night. Even in those who only did exercises during one study, all participants reported improved nasal breathing.
- Less jaw and neck tension: Many patients report reduced tightness in the head and neck area following treatment.
This surgery has a decent satisfaction rate, with one study reporting between 57% and 75% of adult participants saying that their quality of life improved.
Is This Right For You?
The research suggests that you don’t always need surgery right away. Many doctors recommend trying Myofunctional Therapy first.
In one of the studies we mention here, there is a 100% satisfaction rate from participants who only did the exercises, as opposed to combining it with the surgery.
If your symptoms get better from exercises alone, you may not need surgery at all. If your tongue is too restricted to do the exercises properly, the frenectomy is what makes therapy possible.
FAQs About Adult Frenectomy
What is a tongue tie?
Tongue-tie means the piece of tissue connecting the underside of your tongue to the floor of your mouth is too short or tight. This limits how freely your tongue can move.
How do I know if I have tongue-tie as an adult?
A dentist or oral surgeon can formally evaluate you. Common signs include difficulty lifting your tongue to the roof of your mouth, a tongue that looks heart-shaped or notched at the tip, trouble with certain speech sounds, difficulty swallowing some foods, chronic jaw or neck tension, and snoring or poor sleep.
Will this fix my sleep apnea?
It may help, especially for mild to moderate cases. Research shows people feel less tired and sleep better after treatment. However, the procedure on its own did not significantly reduce the clinical number of sleep interruptions in the studies reviewed. It works best as part of a broader plan that includes tongue exercises. If you have severe sleep apnea, CPAP remains the primary treatment.
Do I need surgery, or can I just do the exercises?
Many people do well with exercises alone. Surgery is typically recommended when the tongue is too physically restricted to perform the exercises correctly.
Will my speech change?
It can. Adults may have built up compensatory speech habits over many years of restricted tongue movement, and it is supported by research that phonation can be improved in adult patients.
Does the tongue-tie grow back after surgery?
The tissue itself does not regenerate. However, if you skip your post-operative stretching exercises, scar tissue can form and re-restrict the tongue. This is why keeping up with exercises after surgery is considered essential, not optional.
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