Dr Ameen

Article written by Dr Ameen, ENT Specialist Kuala Lumpur

Ankyloglossia, commonly known as tongue tie, occurs when a short or tight band of tissue tethers the bottom of the tongue to the floor of the mouth. Frenotomy or tongue tie release is a minor surgical procedure that divides this restrictive tissue. I perform this using sterile surgical scissors or a soft tissue laser under direct vision. The surgery takes 10 to 15 minutes. Most infants and children undergo this as a day procedure. You can expect mild discomfort and a small white diamond shaped patch under the tongue as it heals. This white patch is normal granulation tissue and not an infection. Babies can usually breastfeed or bottle feed immediately after the procedure. The average hospital stay is zero nights, as patients go home the same day.

Understanding the Procedure and Recovery

The procedure is straightforward and highly effective. After administering a local anaesthetic or brief general anaesthetic for older children, I gently lift the tongue. I then divide the tight frenulum with precise movements. For laser frenotomy, the laser simultaneously cuts and seals the tissue, minimising bleeding. No stitches are required.

Post operative care focuses on preventing the wound from reattaching. Parents of infants are taught specific tongue stretches to perform several times a day for two to three weeks. Older children and adults may receive simple mouth exercises. Mild fussiness or soreness is normal for the first 24 to 48 hours. Over the counter pain relief is usually sufficient. Most patients resume normal feeding and daily activities immediately.

Indications for Frenotomy

I recommend this procedure only when the restricted tongue movement causes functional problems. The strongest clinical reasons include:

• Infant feeding difficulties: Inability to latch properly, poor weight gain, excessive gas, or severe maternal nipple pain and damage during breastfeeding.
• Speech articulation issues: Difficulty pronouncing specific sounds like “t”, “d”, “z”, “s”, “th”, “r”, or “l” in older children, confirmed by a speech therapist.
• Mechanical restrictions: Inability to protrude the tongue past the lower incisors or lift it to the upper palate, limiting normal oral function.
• Oral hygiene challenges: Inability to sweep food debris from the teeth, leading to an increased risk of dental caries and gum disease.
• Social or mechanical discomfort: Tongue tie causing issues with playing wind instruments, kissing, or wearing dentures in adolescents and adults.

Complications of the Procedure

Every surgical procedure carries some level of risk. I discuss these thoroughly during our consultation. The overall safety profile for frenotomy is excellent.

• Minor bleeding: 1 to 2 percent. Usually resolves quickly with gentle pressure or a cold compress.
• Infection: Less than 1 percent. Rare due to the rich blood supply of the oral cavity and natural antibacterial properties of saliva.
• Reattachment or scarring: 2 to 5 percent. The wound may heal back together if post operative stretches are not performed, potentially requiring a secondary release.
• Damage to salivary ducts: Less than 1 percent. Injury to the submandibular ducts is rare when the procedure is performed by an experienced specialist using proper technique.
• Transient feeding refusal: 5 to 10 percent. Infants may fuss or feed less frequently for a day due to mild soreness but typically resume normal feeding within 24 hours.

Estimated Procedure Cost (Professional Fees)

Medical fees in Malaysia are guided by the Private Healthcare Facilities and Services Act. Based on the PHFSA 2013 regulations for frenotomy or frenectomy of the tongue (Code F2620), the maximum allowable professional fees are:

• Surgeon Professional Fee (MINOR 4): RM480
• Anaesthetist Professional Fee (INTER 4): RM435
• Total Maximum Professional Fees: RM915

Total Estimated Cost

• Total Estimated Cost (including hospital facility fees, operating theatre charges, specialised equipment rental, medications, and consumables): RM10,000 to RM12,000
• Disclaimer: This is an estimated total cost only. Actual bills vary significantly depending on the specific hospital, room type, and individual patient needs across Malaysia. Patients should always request a detailed itemised cost estimate from their chosen hospital or medical centre before proceeding.

Frequently Asked Questions

Is the procedure painful for my baby? The procedure itself is very quick and causes minimal discomfort. We use local anaesthetic or brief general anaesthetic to ensure your baby remains comfortable. Any mild soreness afterward is easily managed and rarely requires strong pain medication.

Will my baby be able to feed immediately after? Yes. In fact, feeding immediately after the procedure is highly encouraged. It helps soothe the baby, provides natural comfort, and assists in the initial healing process by keeping the area active.

What is the white patch under my baby’s tongue? A white or yellowish diamond shaped patch under the tongue is completely normal. It is granulation tissue, which is part of the natural healing process, and it is not a sign of infection. It will fade on its own within two weeks.

Can adults get a tongue tie release? Yes. Adults with symptomatic ankyloglossia can undergo this procedure. While the healing process may take slightly longer than in infants, adults often experience significant improvement in speech clarity, oral hygiene, and mechanical comfort.

Do I need to do exercises after the surgery? Yes. Post operative stretches or exercises are critical to prevent the tissue from reattaching as it heals. I will provide clear, step by step instructions and demonstrate the correct technique before you leave the clinic.

When to Seek Consultation

Living with feeding struggles or speech difficulties can be stressful for both parents and children. A simple tongue tie release can resolve these issues quickly and safely, improving quality of life and daily function.

If you suspect your infant is struggling to latch, or if your child has persistent speech articulation problems, do not wait for the issue to resolve on its own. Book a consultation at my Kuala Lumpur clinic for a thorough oral examination. We will assess the severity of the tongue tie and discuss whether a frenotomy is the right step for your family.

About the Author

Dr. Ameen is a Resident Ear, Nose & Throat Consultant at KPJ Ampang Puteri Specialist Hospital, situated in Selangor near the Kuala Lumpur border and serving patients from both Ampang and Kuala Lumpur.

He earned his medical degree (MB BCh BAO Hons) in Ireland and completed his Master of Otorhinolaryngology at Universiti Kebangsaan Malaysia. With comprehensive tertiary training from Hospital Kuala Lumpur and Hospital Tunku Azizah, he expertly manages complex adult and pediatric ENT conditions, including sinus, ear, throat, and vertigo disorders.

Before taking on his current role as a Resident ENT Consultant at KPJ Ampang Puteri Specialist Hospital, Dr. Ameen spent three years building extensive private center experience in Kuala Lumpur as a sessional ENT Consultant at Sunway Medical Centre Velocity and Columbia Asia Hospital Setapak.ally invasive techniques to ensure the best functional outcomes for his patients.