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 Table of Contents  
REVIEW ARTICLE
Year : 2016  |  Volume : 10  |  Issue : 2  |  Page : 34-36

Untangle the lingual aberrant frenum by diode laser: A case report with review of literature


1 Department of Periodontology, Career P.G. Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Surgery, Career P.G. Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
3 Department of Pedodontics and Preventive Dentistry, Career P.G. Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
4 Department of Periodontology, Chandra Dental Collage, Barabanki, Uttar Pradesh, India

Date of Web Publication29-Dec-2016

Correspondence Address:
Mohammad Arif Khan
Department of Periodonology, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-1385.196953

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  Abstract 

A frenum is an anatomic structure formed by a fold of mucous membrane, connective tissue, and sometimes muscle fibers connecting the lips, cheek, or tongue to the jawbone. Tongue-tie or ankyloglossia is a rare congenital anomaly. In this condition, the tongue is attached to the floor of the mouth and the patient is unable to protrude his tongue properly, difficulty in speech, suction, feeding, and also difficulty in maintaining the oral hygiene has been reported. We report a case of partial ankyloglossia in a 7-year-old male child which was treated with diode laser and followed up by without having any complication.

Keywords: Ankyloglossia, diode laser, lingual frenectomy, tongue-tie


How to cite this article:
Khan MA, Farooqui M, Saimbi CS, Yadav SK, Saxena A. Untangle the lingual aberrant frenum by diode laser: A case report with review of literature. J Dent Lasers 2016;10:34-6

How to cite this URL:
Khan MA, Farooqui M, Saimbi CS, Yadav SK, Saxena A. Untangle the lingual aberrant frenum by diode laser: A case report with review of literature. J Dent Lasers [serial online] 2016 [cited 2017 Apr 25];10:34-6. Available from: http://www.jdentlasers.org/text.asp?2016/10/2/34/196953


  Introduction Top


Lingual frenulum is formed by a dense fibrous conjunctive tissue and often by superior fibers of the genioglossus muscle. It connects the tongue to the floor of the mouth, allowing tongue's free movement. Partial ankyloglossia, also called as tongue-tie, is a condition caused by abnormally short frenum of the tongue, or the frenum is attached too close to the tip of the tongue. The other category is total ankyloglossia which is rare and occurs when the tongue is completely fused to the floor of the mouth. The incidence of tongue-tie varies from 0.2% to 5% depending on the population examined with a male child predilection. [1],[2] Ankyloglossia or tongue-tie affects speech, feeding, oral hygiene, as well as social environment. Moreover, it interferes in tooth brushing process, consequently, favoring the onset, risk of plaque accumulation, tissue inflammation, and gingival recession. [3] Frenectomy provides the tongue mobility because no adherence is formed after the incision of the frenulum.


  Case Report Top


A 7-year-old male child with their parents reported to the Department of Pedodontics with a chief complaint of difficulty in speech and maintaining oral hygiene; from there, he was then referred to the Department of Periodontology, for the management of mucogingival problem. Patient's medical and family history was noncontributory. Extraoral examination revealed no significant finding. However, intraoral examination showed restricted tongue movement, with only 8 mm of tongue protrusion [Figure 1]. This was due to the presence of fusion of lingual frenum to the tongue. In addition, the patient was not able to place brush on the lingual side of anterior mandible due to the position of frenum. Informed consent was taken from patient's parent.
Figure 1: Preoperative view

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Lingual frenectomy procedure was planned, and the patient's parent was informed about the procedure; however, the patient was apprehensive of conventional lingual frenectomy procedure. Hence, to release the patient stress, diode lasers are selected for the management of tongue-tie and give the patient a painless treatment.

Surgical procedure

The frenum was grasped with tissue holding forceps as close to the base of the tongue as possible, and the tip of fiber optic was held perpendicular or oblique direction to the frenum in contact mode between the laser tip and tissue surface [Figure 2], then frenectomy was done with diode laser (980 nm) under topical anesthesia [Figure 3]. The procedure was completed by cutting first above and down avoiding the vessels and glands in the floor of the mouth to be ruptured and there was no need of suture.
Figure 2: Grasped the frenum at the base of tongue with tissue holding forceps and the tip of fiber optic laser hold in perpendicular or oblique direction to the frenum

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Figure 3: Frenectomy done

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The patient was recalled after 1 week. As a post treatment result, the patient was able to protrude his tongue up to 17 mm [Figure 4]. He was following the oral hygiene instructions and was able to brush even on the lingual side.
Figure 4: Postoperative view after 1 week

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  Discussions Top


Ankyloglossia, a rare congenital anomaly, occurs due to the failure in cellular degeneration leading to a longer anchorage between tongue and floor of the mouth. [4] Kotlow classified tongue-tie as Class I (mild ankyloglossia: 12-16 mm), Class II (moderate ankyloglossia: 8-11 mm), Class III (severe ankyloglossia: 3-7 mm), and Class IV (complete ankyloglossia: <3 mm). [5] According to this classification, our case was of Class II moderate ankyloglossia with tongue protrusion of 8 mm. There are various surgical methods to treat ankyloglossia, such as frenectomy by simple excision of frenum; Z plasty, as described by Kaban, has an advantage of also lengthening the scar and providing an increased potential for the postoperative tongue mobility; the technique is, however, more complex.

Erbium:YAG lasers and diode lasers are becoming popular over conventional techniques because the laser is a less invasive method and ability to seal lymphatic channels which results in reduced postoperative edema, also the sealing of nerve endings resulting in reduced inflammatory response, and the formation of a fibrin clot over the surgical wound that protects the wound from external irritation, causing less pain after surgery, and avoiding the use of analgesic drugs. [6]

Photothermal interaction with tissue is the basic concept of surgical laser. In this process, radiant light is absorbed by the tissue and transformed to heat energy changing tissue structure. Laser light within was converted to thermal energy on contact with the tissue, causing laser tissue interaction that when appropriately applied can produce reaction ranging from the incision, vaporization, to coagulation. [7],[8] This wavelength has an affinity for melanin or dark pigments and is strongly absorbed by the blood hemoglobin, which contributes to their thermal effect. Therefore, this laser works more efficiently when the energy applied in the presence of pigments. This was the reason that homeostasis occurs with this wavelength. Electrosurgery is also suggested as an economical alternative; however, its use is limited to the milder form of ankyloglossia and a second visit is required for releasing the tongue. [1] In our study, the use of 980 nm diode laser allowing increased surgical precision and accuracy, thereby reducing unnecessary damage to underlying tissues, and the procedure was with no bleeding, resulting in improving visualization of the surgical field and shortening the operation time. There was no need of sutures because of the coagulated layer formed over the raw area with no evident bleeding, and also to avoid the primary intention healing and reattachment. [9],[10]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Darshan HE, Pavithra PM. Tongue tie: From confusion to clarity-a review. Int J Dent Clin 2011;3:48-51.  Back to cited text no. 1
    
2.
Ballard JL, Auer CE, Khoury JC. Ankyloglossia: Assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics 2002;110:e63.  Back to cited text no. 2
    
3.
Yared EFG, Zenobio EG, Pacheco W. The multi-factorial etiology of periodontal recession. Rev Dent Press Ortodon Ortop Facial 2006;11:45-51.  Back to cited text no. 3
    
4.
Morowati S, Yasini M, Ranjbar R, Peivandi AA, Ghadami M. Familial ankyloglossia (tongue-tie): A case report. Acta Med Iran 2010;48:123-4.  Back to cited text no. 4
    
5.
Kotlow LA. Ankyloglossia (tongue-tie): A diagnostic and treatment quandary. Quintessence Int 1999;30:259-62.  Back to cited text no. 5
    
6.
Pié-Sánchez J, España-Tost AJ, Arnabat-Domínguez J, Gay-Escoda C. Comparative study of upper lip frenectomy with the CO2 laser versus the Er, Cr:YSGG laser. Med Oral Patol Oral Cir Bucal 2012;17:e228-32.  Back to cited text no. 6
    
7.
Catone GA, Alling C. Laser Application in Oral and Maxillofacial Surgery. 1 st ed. Philadelphia: W.B. Saunders Company; 1997. p. 30-40, 115-46, 181-93.  Back to cited text no. 7
    
8.
Kishen A, Asundi A. Fundamentals and Applications of Biophotonics in Dentistry, Series on Biomaterials and Bioengineering. Vol. 4. London: Imperial College Press; 2007. p. 123-51.  Back to cited text no. 8
    
9.
Tuncer I, Ozçakir-Tomruk C, Sencift K, Cöloglu S. Comparison of conventional surgery and CO2 laser on intraoral soft tissue pathologies and evaluation of the collateral thermal damage. Photomed Laser Surg 2010;28:75-9.  Back to cited text no. 9
    
10.
Kotlow LA. Using the erbium: YAG laser to correct abnormal lingual frenum attachments in newborns. J Acad Laser Dent 2004;12:22-3.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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