The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review

Int J Pediatr Otorhinolaryngol. 2013 May;77(5):635-46. doi: 10.1016/j.ijporl.2013.03.008. Epub 2013 Mar 26.


Objective: To systematically review the outcomes of tongue-tie division procedures in patients with ankyloglossia with the goal of (1) deriving clinically oriented insights into the effect of tongue-tie division procedures and (2) identifying needs in knowledge to stimulate further research.

Data sources: Medline, EMBASE, and Cochrane databases were searched without any limitations, for studies published between 1966 and June 2012.

Review methods: Studies were included (level 4 evidence or above) if subjects of any age had ankyloglossia and underwent tongue-tie release. Outcome measures of interest were any subjective or objective measures of breastfeeding and speech outcomes, or reports of adverse events.

Results: In all, 378 abstracts were generated from the literature searches; 20 studies met the criteria for data extraction and analysis. Of those, 15 studies were observational and 5 were randomized controlled trials. Tongue-tie division provided objective improvements in the following: LATCH scores (3 studies); SF-MPQ index (2 studies); IBFAT (1 study); milk production and feeding characteristics (3 studies); and infant weight gain (1 study). Subjective improvements were also noted in maternal perception of breastfeeding (14 studies) and maternal pain scores (4 studies). No definitive improvements in speech function were reported. The only significant adverse events were recurrent tongue-ties that required repeat procedures.

Conclusion: Ankyloglossia is a well-tolerated procedure that provides objective and subjective benefits in breastfeeding; however, there was a limited number of studies available with quality evidence. There are no significant data to suggest a causative association between ankyloglossia and speech articulation problems. Aspects of ankyloglossia that would benefit from further research are described, and recommendations for tongue-tie release candidacy criteria are provided.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Ankyloglossia
  • Articulation Disorders / surgery*
  • Breast Feeding
  • Humans
  • Lingual Frenum / abnormalities*
  • Lingual Frenum / surgery
  • Mouth Abnormalities / complications
  • Mouth Abnormalities / surgery*
  • Speech / physiology*
  • Treatment Outcome