what are the signs?pre and post therapyfollow-ups

functional frenuloplasty

This procedure is typically done for older children (3+years) who have a submucosal tongue restriction (or "posterior tongue-tie").  Posterior tongue ties may lead to issues such as delayed speech, difficulty with chewing/swallowing, choking on food, mouth-breathing and sleep-disordered breathing. Dr. Tran highly recommends myofunctional therapy in conjunction with this procedure for a successful long-term outcome. 

diagnosing through function

Diagnosing a posterior tongue tie can be quite tricky. It takes having a sharp understanding of oral motor function, which is not something most medical doctors and dentists learn in their formal education. Dr. Tran has taken the initiative to expand her knowledge and understanding on oral motor function through numerous hours of continuing education, and learning from her trusted network of therapists. Her philosophy is to take the conservative approach by using therapeutic progress as a way to assess the need for a tongue tie release.

what are the functional signs?


Children with posterior tongue ties may experience the following speech difficulties: 

  • Delayed speech
  • Articulation disorders
  • Improper tongue placement
  • Speaking quietly/mumbling
  • Voice hoarseness
  • Nasality when speaking


A typical swallow requires the entire tongue to lift UP against the roof of the mouth. When it cannot, here's what your child may experience:

  • Choking/coughing on certain textured foods
  • Tongue thrust (reverse swallow)
  • Hyperactive gag reflex
  • Excess drooling
  • Inability to lateralize the tongue
  • Slurping


When the tongue is tied down, it stays LOW. Low tongue posture leads to mouth breathing, which will result in:

  • Decreased airflow
  • Shallow breathing
  • Decreased oxygen during sleep
  • Snoring or heavy breathing
  • Narrow upper jaw
  • High palatal vault (roof of mouth)

how to fix it correctly

A functional frenuloplasty requires releasing bands of tension beneath the tongue as your child performs oral motor exercises. You can't always see them, so you have to feel them! What does this mean? Your child must do some pre-therapy to prepare them for the surgery. This also helps Dr. Tran to identify the restrictive bands of tissue. Once the release is complete, Dr. Tran will place resorbable sutures to close up the wound. Pain is minimal (nothing that Tylenol or Motrin can't help!)

Worried your child can't handle it? Don't worry! Dr. Tran is a compassionate, board-certified pediatric dentist who can make your little one feel at ease. If they need a little more to take the edge off, Dr. Tran is licensed to administer nitrous oxide, oral conscious sedation, and works with her anesthesiologist of choice to provide in-office deep sedation.

pre- and post-therapy


Myofunctional therapy must be done prior to the frenuloplasty in order to prepare your child's associated musculature for the tongue's new range of motion. Think of it as strengthening the supporting muscles so the recovery can be easier! Dr. Tran refers to the best therapists in town who have experience in treating children with tongue tie issues


Once the procedure is complete, your child will have a whole new range of motion- they won't quite know what to do with it! They can actually start using it right away, and no diet restrictions (yay!) Since there will be sutures in place, Dr. Tran recommends waiting 3 to 5 days before slowly getting back into the myofunctional therapy.

pain management

Your child will be given local anesthesia for this procedure. As for afterward? Dr. Tran recommends staying ahead of the pain by giving motrin or tylenol around the clock. Bonus- cold tends to help soothe the under-the-tongue discomfort, so stock up on your little one's favorite popsicles or ice cream!


Dr. Tran recommends following up within 1 week post-release. No need to return for suture removal because they will dissolve on their own. Be sure to schedule an appointment with your myofunctional therapist as directed so they can give you some light stretches and exercises. They will tailor those exercises to your child's individual needs! .

Dr. Tracy Tran prides herself on going the extra mile. Quite literally. Experience your doctor’s care from the comfort of your home in a concierge appointment or from her accessible locations across the LA county area.
Get in touch for pricing and availability.