Doctor Stewart, Otorhinolaryngologist-in-chief at New York Presbyterian Hospital, explains the different types of surgery that must be done according the the varying level of severity of the tongue tie.

Doctor Stewart: In certain cases, actually, there's just not enough tissue there. It's actually almost a fusion issue of some of the tongue to the floor of the mouth and even if you cut it there's still not enough mobility. The bottom line is you're trying to cut the tie so that you know, it's too thick and too long, they're supposed to be able to tie there. But it's supposed to be small and in the mid-line and fairly far back, relatively speaking. So in some patients, particularly in very young children, with the very thin membranous tie that's not severe, you can very simply under anesthesia, just snip it. And in fact the tissue retracts quickly and that's all you need to do. So it's a very quick and easy operation. In fact, many times kids are just given some breathing gas, just briefly go to sleep, snip it and they wake up and it's very quick. They don't even need to have a breathing tube inserted, for example. If it's a thicker tie, if it's a longer tie, there's an older child with more tissue, then I think you need to do a bit of a more extensive repair. In other words if you just cut it, it will have a tendency to contract back down again and partially tether. So then you would need to do, maybe a couple of different cuts, using some sutures to try to close things up for better healing. And in certain cases, actually, there's just not enough tissue there. It's actually almost a fusion issue of some of the tongue to the floor of the mouth and even if you cut it, there's still not enough mobility. So then you would have to do some rotation of tissue, some flaps and some sort of techniques like are used in plastic surgery elsewhere, some sort of rotational techniques to actually borrow tissue from someplace else to recreate some mobility of the tongue. And that's an even more extensive sort of procedure.