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Ankyloglossia, or tongue-tie, is the result of a short, tight, lingual frenulum causing tethering of the tongue tip. Although most cases resolve or are asymptomatic, some patients develop articulation problems and other concerns related to poor tongue-tip mobility. In this study, we evaluated the treatment of patients greater than 3 years of age with persistent articulation problems related to ankyloglossia (n = 16). All patients underwent surgical correction either via a novel application of the 4-flap Z-frenuloplasty (n = 11) or via the more traditional horizontal-to-vertical frenuloplasty (n = 5). Frenulum length, tongue protrusion length, and speech evaluations (4-grade scaling) were documented preoperatively and at follow-up.For the 4-flap Z-frenuloplasty, 91% of patients showed at least 2orders of improvement in speech, 64% showed complete resolution of articulation errors, and 9% demonstrated no improvement in speech. Frenulum length and tongue protrusion gained 37.5 ± 13.5mm (P < 0.001) (315% increase) and 36.2 ± 7.6 mm (P < 0.001), respectively. In contrast, with the horizontal-to-vertical frenuloplasty, only 40% showed 1 order of improvement in speech, and 60% had no change in articulation. Frenulum length and tongue protrusion gained 11.2 ± 4.15 mm (98% increase) and 13.2 ± 2.6mm (P = 0.0003), respectively.Our data indicated that the 4-flap Z-frenuloplasty was superior to the horizontal to vertical frenuloplasty with respect to tongue lengthening, protrusion, and articulation improvement for patients with symptomatic ankyloglossia.