Obstructive sleep apnea (OSA) is a multifactorial condition in which structural and functional abnormalities contribute to airway collapse during sleep. While adenotonsillectomy remains the first-line treatment in pediatric cases, up to 17% of children present with residual symptoms, prompting the need to explore less commonly assessed anatomical factors such as a short lingual frenulum (ankyloglossia). Despite early observations linking ankyloglossia with OSA, particularly in work by Guilleminault, this association remains controversial and is not currently included in clinical guidelines. This chapter explores the epidemiology, pathophysiology, diagnostic criteria, and treatment considerations related to ankyloglossia and its possible role in pediatric OSA. We review current evidence, including recent meta-analyses, case studies with pre- and posttreatment drug-induced sleep endoscopy (DISE), and emerging diagnostic classifications. Emphasis is placed on the interplay between restricted tongue mobility, craniofacial development, and muscular function, as well as the potential benefits of a combined surgical and myofunctional therapeutic approach. The chapter also outlines surgical techniques, postoperative considerations, and associated risks, underscoring the need for a comprehensive and cautious approach to diagnosis and intervention.