Pediatric Tongue Ties

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Tongue & Lip Ties in Toddlers - Putting Everyone at Ease

When it comes to tongue and lip ties, “toddlerhood” can be tricky for parents. Parents sometimes get a bit nervous at the thought of their little ones having a tongue or lip tie procedure. It’s understandable. In our experience, diagnosing and treating toddlers with tongue and lip ties can be a bit more involved and intricate than treating an infant. Dr. Green has done thousands of procedures. In this short video she talks about how she puts everyone at ease before, during and after the procedure.

Obtaining a Precise Diagnosis Is the First Step in Achieving a Successful Treatment Outcome

Experience has re-inforced for Dr. Green and her team that an accurate diagnosis exponentially increases the chances of a successful treatment outcome. The first step in her process is a simple (but very thorough) oral exam. She uses a research-based examination protocol called the Tongue Range of Motion. It’s a “best in class” scoring system that gives her the tools she needs to accurately grade tongue function and confidently diagnose the severity of any restrictions.
In some cases she will also recommend 3D imaging of the oral cavity. This additional information helps her to assess areas of the anatomy that she can’t see during the oral exam. If Dr. Green’s examination uncovers restricted or tethered oral tissue, we DO NOT recommend leaving the condition untreated.

Functional Classification of Ankyloglossia Based on Tongue Range of Motion (TRMR)

Grade 1 Functioning: TRMR > 80%
Grade 2 Functioning: TRMR 50-80%
Grade 3 Functioning: TRMR < 50%
Grade 4 Functioning: TRMR < 25%

Why We DO NOT RECOMMEND Putting off Treatment for Tongue Ties

Proper functioning of the tongue is directly related to airway health, proper facial growth and jaws that develop to their full potential. A restricted tongue can (and quite often does) set off a cascade of structural problems that can lead to:
  • Difficulty consuming solid foods
  • Hampered and/or delayed speech development
  • Chronic mouth breathing
  • Snoring
  • Symptoms that mirror ADD/ADHD
  • Fatigue and lack of energy
  • Poor Sleep
  • Pediatric OSA (Obstructive Sleep Apnea) or other sleep related breathing disorders
  • Crowded and crooked teeth
  • Narrow upper and lower jaws
  • Long faces
  • Flat cheeks/weak profile
  • TMJ pain & other jaw joint problems

Two World Leaders in Sleep & Airway Talk About the Long Term Implications of Untreated Tongue & Lip Tie

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About Dr. Zaghi

Dr. Soroush Zaghi is the Founder of The Breathe Institute and a pioneer in tongue tie diagnosis and treatment. Dr. Zaghi received his medical degree from Harvard Medical School. He completed his residency in ENT (Otolaryngology- Head and Neck Surgery) at UCLA, followed by a Sleep Surgery Fellowship at Stanford University. His specialized training focuses on providing comprehensive treatment for various conditions, including tongue-tie, nasal obstruction, mouth breathing, snoring, and obstructive sleep apnea. Dr. Zaghi is also deeply involved in clinical research related to sleep-disordered breathing, and has published over 80 peer-reviewed research papers in the fields of neuroscience, head and neck surgery, and sleep-disordered breathing.

About Dr. Simmons
Dr. Jerald Simmons is triple board-certified in Neurology, Epilepsy, and Sleep Medicine. He graduated from Ohio State University, did his Neurology residency at Washington University, completed a Sleep Medicine Fellowship at Stanford University, and an Epilepsy Fellowship at University of California. Dr. Simmons started his career as an Assistant Professor of Neurology at UCLA, where he also co-directed the UCLA Sleep Disorders Center and managed the Clinical Neurophysiology lab at Olive View UCLA Medical Center. He lectures nationwide and is the Founder of Comprehensive Sleep Associates (CSMA) in Houston TX.
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Functional Frenuloplasty - The Tongue Tie Release Surgical Procedure

The frenulum is the cord that attaches the tongue to the bottom of the mouth. When the frenulum is too tight, short or poorly positioned, it is referred to as a tongue tie. A tongue tie release, also known as a frenctomy or frenuloplasty, is a minor surgical procedure that removes or loosens the frenulum.
One of the most common side effects of a tongue tie release is re-attachment. Re-attachment occurs when the frenulum grows back to its original state after the surgery. Risk of re-attachment can be dramatically reduced by using a team approach and by following protocols that have been validated through intensive clinical research.
Dr. Green and her team use a functional frenuloplasty protocol to release tongue ties. Myofuctional therapy (and sometimes craniofacial therapy) are used before and after the surgical procedure to reduce the risk of re-attachment and increase the chances of a successful outcome.

For Best Results with Minimal Invasiveness, We Adhere to Research Based Protocols and Utilize 2 Lasers During Our Frenuloplasty Procedures

By collaborating as a team with expertise in multiple disciplines, we can identify infants who may benefit from evaluations by: physical therapists, occupational therapists, chiropractors, cranial sacral therapists, or other specialists. We do this before recommending treatment to give our patients the best chance at a successful outcome.. It is our belief that babies and their parents need strong pre and post-operative care, compassionate counseling, easy to understand education, and most importantly a strong support system.
Before The Procedure

If a tongue tie is present that needs to be released, Myofunctional Therapy (and sometimes Craniosacral Therapy) exercises are prescribed. Our therapists help patients perform pre-procedure  Myofunctional Therapy exercises to create “muscle awareness”,  strengthen and tone the tongue and “wake up” parts of the child’s tongue that have been dormant. As soon as the child can perform the prescribed exercises proficiently, he or she will be scheduled for the release procedure.


Most kids over 3 years old thrive in our Mini-Myo program.  Exercises are designed to tone and strengthen the tongue and face. Sessions also help to “desensitize” children to our office and prepare them for their upcoming procedure.  We have the children sit in the dental chair, show them the fun instruments we may use, and talk them through the appointment process so they feel comfortable and excited by the time their real appointment arrives. For our most anxious patients, we offer nitrous oxide or laughing gas to make the experience as comfortable as possible. 

During The Procedure

The surgical site is prepared with PhotoBioModulation Therapy.  The Summus Laser that is used for this phase of the procedure “pre-loosens” the tissues including the fascia so that we can perform the most minimally invasive release. 


The frenectomy itself is performed with a state-of-the-art LightScalpel CO2 laser. (Learn more about it here)  The LightScalpel CO2 Laser is very safe and extremely precise.  Precision in a tongue tie release procedure translates to minimal bleeding and less post operative pain.  Our hybrid technique (Summus Laser + Light Scalpel CO2 Laser) is designed to maximize tongue mobility and improve overall function.


Dr, Green prefers to use sutures to close wounds (except in infants) because they facilitate the best healing and require the least amount of home care. 

Immediately after the tongue tie release, we will sit with your child to make sure he or she feels physically comfortable, emotionally safe and is ready to head home.  Before you leave, we will give you post-op instructions and answer any questions you may have.

After the Procedure

Follow-up visits are critical for optimal healing.  During the initial post op visits, we will  re-introduce PhotoBioModulation Therapy with the Summus Laser.  This treatment will decrease pain, reduce inflammation and promote optimal healing. 


Virtual post op visits are available for questions, concerns and routine post-acute follow up. 


We may suggest myofunctional therapy and/or craniosacral therapy as part of your child’s post procedure rehabilitation program. The exercises and functional improvements that the therapists prescribe are all designed to improve your child’s posture, breathing, speaking, feeding, chewing, and growth.

Commitment to Excellence

To keep our standards high and help other providers around the world, we submit our procedures and results to respected medical journals and other publications. Our cases are rigorously reviewed by medical editorial teams who determine if they are suitable for publication.