Intended for healthcare professionals

Practice Clinical Opinion

Posterior tongue tie and lip tie: a lucrative private industry where the evidence is uncertain

BMJ 2020; 371 doi: (Published 26 November 2020) Cite this as: BMJ 2020;371:m3928
  1. Lyndsay Fraser, consultant ear, nose, and throat surgeon1,
  2. Stuart Benzie, staff grade ear, nose, and throat surgeon1,
  3. Jenny Montgomery, consultant ear, nose, and throat surgeon2
  1. 1Crosshouse Hospital, Kilmarnock, UK
  2. 2Queen Elizabeth University Hospital, Glasgow, UK
  1. Contact Lyndsay Fraser lyndsayfraser{at}

Private practitioners are offering “posterior tongue tie” or “lip tie” division to newborns with feeding difficulties, despite a paucity of evidence in this area.

A tongue tie (or ankyloglossia) occurs when the frenulum of the tongue is abnormally short or tight, and is estimated to occur in 4-11% of newborns.1 In some infants the condition can interfere with the ability to latch and can contribute to feeding difficulties, weight loss, and maternal mastitis. Diagnosis is subjective, on the basis that the lingual frenulum is seen to be short or tight and causing restriction of tongue movement.

The evidence base for ankyloglossia division is generally weak, but in the UK standard practice is to offer to divide the visibly tight frenulum in …

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