Division of ankyloglossia (tongue tie) has been used for many years (i.e. not a new procedure). This procedure was notified to the Interventional Procedures programme in July 2004 because of controversy about its safety and efficacy in the treatment of babies with feeding difficulties. Therefore it was considered important for the Interventional Procedures Advisory Committee to consider this procedure, and for NICE to issue guidance to the NHS.

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on division of ankyloglossia (tongue tie) for breastfeeding.


Ankyloglossia, also known as tongue-tie, is a congenital anomaly characterised by an abnormally short lingual frenulum; the tip of the tongue cannot be protruded beyond the lower incisor teeth. It varies in degree, from a mild form in which the tongue is bound only by a thin mucous membrane to a severe form in which the tongue is completely fused to the floor of the mouth. Breastfeeding difficulties may arise as a result of the inability to suck effectively, causing sore nipples and poor infant weight gain.

Many tongue-ties are asymptomatic and do not require treatment; some may resolve spontaneously over time. If the condition is causing problems with feeding, conservative treatment includes breastfeeding advice and counselling, massaging the frenulum, and exercising the tongue. Some practitioners, however, believe that if a baby with tongue-tie has difficulty breastfeeding, surgical division of the lingual frenulum should be carried out as early as possible. This may enable the mother to continue breastfeeding rather than having to switch to artificial feeding.  

If division of the tongue-tie is performed in early infancy, it is usually performed without anaesthesia, although local anaesthetic is sometimes used. In an older infant or child, however, general anaesthesia is usually required. The baby is swaddled and supported at the shoulders to stabilise the head and sharp, blunt-ended scissors are used to divide the lingual frenulum. There should be little or no blood loss and feeding may be resumed immediately.

Coding recommendations


SNOMED CT preferred term (concept ID)

Incision of lingual fraenum (7001008)


F26.3 Incision of frenulum of tongue

Includes: Frenotomy of tongue

Diagnosis or health condition

SNOMED CT preferred term (concept ID)

Tongue tie (67787004)