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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 11  |  Issue : 2  |  Page : 65-68

Treatment of ankyloglossia by diode laser


Departments of Periodontology, SMBT Dental College and Hospital, Sangamner, Maharashtra, India

Date of Web Publication29-Dec-2017

Correspondence Address:
Dr. Harshal P Patil
Department of Periodontology, SMBT Dental College and Hospital, Sangamner, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdl.jdl_17_17

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  Abstract 

The most common developmental anomaly of the tongue is ankyloglossia which is characterized by a short, thick lingual frenum resulting in limitation of tongue movement, speech problems, and feeding problems in neonates. Failure in early diagnosis of this anomaly results in social communicating and mechanical problems in an individual. If clinicians diagnose and treat this in early childhood by frenectomy, speech problems can be overcome by speech therapy, but due to ignorance of individual's parents and by clinician, sometimes this anomaly remains undetected and produces speech problems throughout the life. In spite of the treatment in an adult individual of an ankyloglossia, speech therapy rarely improves individual's speech problems. This is a case report of an ankyloglossia treatment by a diode laser in an adult.

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


How to cite this article:
Patil HP, Bhoir SS. Treatment of ankyloglossia by diode laser. J Dent Lasers 2017;11:65-8

How to cite this URL:
Patil HP, Bhoir SS. Treatment of ankyloglossia by diode laser. J Dent Lasers [serial online] 2017 [cited 2019 May 26];11:65-8. Available from: http://www.jdentlasers.org/text.asp?2017/11/2/65/221999


  Introduction Top


The lingual frenum is a fibromucosal fold it connects the ventral surface of the tongue to mucosa of the floor of mouth. Sometimes, due to developmental errors, this lingual frenum remains short and thick, which causes fusion of tongue to the floor of mouth resulting in limited tongue movement ankyloglossia.[1] The developmental anomalies of the lingual frenum can be classified according to different levels of gravity. The frenum presents an alveolar and a lingual placing. Its insertion may vary from the tip of the tongue (ankyloglossia) to little away (<2 cm) or very far (>2 cm) from the tip. The alveolar insertion can be marginal at the neck of the tooth, or apical, i.e., at apex of the tooth root, or subapical, i.e., below the apex of the tooth. The presence of a short lingual frenum may be responsible for the low mobility of the tongue.

Different levels of gravity of the anomalies of the lingual frenum on the basis of the type of lingual insertion are as follows.[2]

  • Level F0 - The frenum is absent
  • Level F1 - The frenum goes from sublingual caruncle to the lower portion of the tongue, with an insertion at the lingual tip
  • Level F2 - The frenum goes from sublingual caruncle at half the distance between the plane of the lips and the plane of the tongue, that is, not far from the lingual tip
  • Level F3 - The frenum has marginal alveolar insertion and lingual connection to the median raphe of the tongue away from the tip of the tongue itself.


Another clinically acceptable Kowtow's assessment most commonly used to classify ankyloglossia depending on the movement of the tongue (in mm), as follows.[1]

  • Clinically acceptable: >16 mm
  • Class I (mild): 12–16 mm
  • Class II (moderate): 8–11 mm
  • Class III (severe): 3–7 mm
  • Class IV (complete): <3 mm.


Milder forms of ankyloglossia often resolve with growth, but severe forms often need treatment irrespective of age. In newborn babies, ankyloglossia may cause feeding problems and in adult speech and swallowing problems, dental caries due to food debris not being removed by the tongue action of sweeping the teeth and spreading of saliva. Malocclusions such as open bite due to thrust created by being tongue-tied, spreading of lower incisors with periodontitis, and tooth mobility due to long-term tongue thrust. In older individuals, it may cause ill-fitting of dentures. There is still bias in practitioners of many specialties, having widely different views regarding its significance and management. In an asymptomatic individual, the condition may resolve spontaneously or they may learn to compensate adequately for their decreased lingual mobility. However, surgical intervention may improve their condition and tongue movement. It is suggested that patients and their parents should be educated about the possible long-term effects of tongue-tie so that they may make an informed choice regarding possible therapy.[3]


  Case Report Top


A 33-year-old male patient reported to the Department of Periodontics S.M.B.T. Dental College, Sangamner, Maharashtra, India, with the chief complaint of bleeding from gums. During initial communication, it was observed that the patient had difficulty in speaking. Careful intraoral examination was done and found that the patient had short lingual frenum, with limited tongue movements along with poor oral hygiene [Figure 1] and [Figure 2]. Limited tongue movement may be the cause of patient's inability to maintain oral hygiene. Difficulty in tongue protrusion was observed. According to Kotlov's assessment, this type of ankyloglossia is diagnosed as type IV.
Figure 1: Preoperative view ankyloglossia

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Figure 2: Preoperative view

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Treatment

The situation, treatment need, and the procedure were explained to the patient. The patient was advised for routine laboratory investigations such as bleeding time, clotting time, hemoglobin count, and complete blood count. After obtaining informed consent from the patient, treatment was initiated. Topical anesthetic gel was applied to the tip and floor of the tongue near frenum attachment. 2% lignocaine 1:80,000 was administered on the tip of the tongue and along the sides of frenum. After signs of complete anesthesia, for retraction purpose, suturing was done to tip of tongue [Figure 3] and frenectomy was initiated using diode (iLase, Biolase, 2.5 W, 940 nm) laser. Tip of laser was applied from the apex of the frenum to the base in a brushing stroke, to cut the frenum [Figure 4]. The ablated tissues were mopped continuously using wet gauze piece. This takes care of the charred tissues and prevents excessive thermal damage to the underlying tissue. Protrusive tongue movement was checked to access complete elimination of frenum [Figure 5] and [Figure 6]. No bleeding was observed, and no suturing was done. The patient was prescribed analgesics and antibiotics, capsule amoxicillin (500 mg) thrice a day for 3 days, and nonsteroidal anti-inflammatory drug tablet ibuprofen (400 mg) + paracetamol (325 mg) thrice a day for 3 days was prescribed to prevent postoperative infection and pain and reviewed after 1-week. Healing was uneventful. The patient reported increased tongue mobility following surgery and was at ease. The patient was referred to a speech therapist for speech improvement.
Figure 3: Suturing for retraction of tongue

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Figure 4: Frenectomy using diode laser

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Figure 5: Presurgical tongue movement

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Figure 6: Postsurgical tongue movement

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  Discussion Top


In pediatric patient, frenectomy is carried out if having feeding problems. Early surgery in a newborn with <3 months had maximum benefit in improving tongue movements; infants were fed in a better way.[4] In adults, indications of frenectomy are malocclusion, due to wrong lingual posture, pathological swallowing, and denture wearer, for pain or instability of the prosthesis itself that the short frenum can create. Sometimes, patients report modification in quality of sleeping or postural problems (neck pain, etc.).

There are many surgical techniques available to manage lingual frenectomy, scalpel frenectomy,[3] electrocautery,[5] and laser frenectomy.[2] In lasers, most commonly used are Er: YAG,[6] CO2 laser,[7] and diode laser.[6] Er: YAG laser has advantage that it can be used without local anesthesia.

Lasers can be successfully used in the treatment of lingual frenectomy. Fear of blood, scalpel, and local anesthesia can be overcome by lasers. Hemostatic, coagulant, and cicatrizing effects are really important; in fact, laser surgery is less invasive, avoids bleeding and suture, and eliminates complications and postoperatory problems. The laser has also an important antibacterial effect that reduces the risk of infections and recidivisms, avoiding the swelling and the inflammation that usually occurs after surgery.

The laser-assisted surgery has several advantages as follows:[8],[9]

  • Precise tissue removal with greater visibility, a clear, dry field due to sealing off the blood vessels, and lymphatic
  • Reduces the risk of bloodborne transmission of disease due to its sterilization effect when it cuts
  • Minimal pain and swelling have been reported after surgery
  • Wound get sealed with a biological dressing so less postoperative infection has been reported
  • Wound healing without scar formation and contraction
  • Less damage to adjacent normal tissue
  • Better access to parts of the oral cavity, e.g., the mandibular lingual, retromolar, and parapharyngeal areas.


Moreover, the use of lasers in frenectomy has advantages such as minimal invasiveness, with a microtraumatic technique and reduced bleeding and scarring; the possibility of an immediate postoperative speech therapy in most cases; the use of topical anesthesia, that it is often sufficient, instead of anesthesia by infiltration; and the reduction of the operative time.[2]


  Conclusion Top


Lingual frenectomy can be successfully done using a diode laser due to its advantages such as no bleeding, no need of sutures, and uneventful healing.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kotlow LA. Ankyloglossia (tongue-tie): A diagnostic and treatment quandary. Quintessence Int 1999;30:259-62.  Back to cited text no. 1
[PUBMED]    
2.
Dezio M, Piras A, Gallottini L, Denotti G. Tongue-tie, from embriology to treatment: A literature review. J Pediatr Neonatal Individ Med 2015;4:e040101.  Back to cited text no. 2
    
3.
Ayer FJ, Hilton LM. Treatment of ankyloglossia: Report of a case. ASDC J Dent Child. 1977;44:69-71.  Back to cited text no. 3
    
4.
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. 4
[PUBMED]    
5.
Verco PJ. Case report and clinical technique: Argon beam electrosurgery for tongue-ties and maxillary frenectomies in infants and children. Eur Archs Paediatr Dent 2007;8:15-9.  Back to cited text no. 5
    
6.
Aras MH, Göregen M, Güngörmüş M, Akgül HM. Comparison of diode laser and Er: YAG lasers in the treatment of ankyloglossia. Photomed Laser Surg 2010;28:173-7.  Back to cited text no. 6
    
7.
Fiorotti RC, Bertolini MM, Nicola JH, Nicola EM. Early lingual frenectomy assisted by CO2 laser helps prevention and treatment of functional alterations caused by ankyloglossia. Int J Orofacial Myology 2004;30:64-71.  Back to cited text no. 7
[PUBMED]    
8.
Rossmann JA, Cobb CM. Lasers in periodontal therapy. Periodontol 2000 1995;9:150-64.  Back to cited text no. 8
    
9.
Rakhewar PS, Patil HP, Thorat M. Diode laser treatment of an oral squamous papilloma of soft palate. J Dent Lasers 2015;9:114-7.  Back to cited text no. 9
  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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