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CASE REPORT
Year : 2018  |  Volume : 12  |  Issue : 2  |  Page : 74-76

Diode laser for lingual frenectomy


Department of Periodontology and Oral Implantology, UCMS College of Dental Surgery, Bhairahawa, Nepal

Date of Web Publication19-Dec-2018

Correspondence Address:
Dr. Soni Bista
Department of Periodontology and Oral Implantology, UCMS College of Dental Surgery, Bhairahawa
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdl.jdl_11_18

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  Abstract 

Ankyloglossia or tongue tie is characterized by short lingual frenum restricting tongue movement which causes feeding difficulties and speech problems. Such condition can be treated by frenectomy using scalpel, laser, and electrocautery. The present case reports ankyloglossia in an 11-year-old female patient treated with diode laser and followed up without any complications.

Keywords: Ankyloglossia, diode laser, frenectomy, lingual frenum


How to cite this article:
Bista S, Adhikari K, Saimbi CS, Agrahari B. Diode laser for lingual frenectomy. J Dent Lasers 2018;12:74-6

How to cite this URL:
Bista S, Adhikari K, Saimbi CS, Agrahari B. Diode laser for lingual frenectomy. J Dent Lasers [serial online] 2018 [cited 2019 Mar 25];12:74-6. Available from: http://www.jdentlasers.org/text.asp?2018/12/2/74/247999


  Introduction Top


Lingual frenum is a mucosal fold that attaches tongue to the floor of the mouth. When it is short and fibrotic, it results in ankyloglossia or tongue tie.[1] According to Kotlow's classification,[2] ankyloglossia is classified as follows:

  • Class I: Mild ankyloglossia: 12–16 mm
  • Class II: Moderate ankyloglossia: 8–11 mm
  • Class III: Severe ankyloglossia: 3–7 mm
  • Class IV: Complete ankyloglossia: <3 mm.


Ankyloglossia affects day-to-day activities such as maintaining speech, feeding, and oral hygiene. Surgical procedures such as frenotomy and frenectomy have been advocated for treating ankyloglossia using scalpel, electrocautery, and laser. Laser frenectomy has several advantages over the other methods.

Here, we report a case of mild ankyloglossia treated with frenectomy using diode laser.


  Case Report Top


An 11-year-old female patient reported to the Department of Periodontology and Oral Implantology, UCMS College of dental surgery, with the chief complaint of difficulty in pronouncing word starting with letter “r,” “t,” and “n” since childhood. Medical history and family history were noncontributory. On extraoral examination, there were no significant findings noted. On intraoral examination, gingiva was inflamed, soft, and edematous; loss of scalloping was observed with generalized bleeding on probing. Furthermore, stain and calculus were present in all the teeth. The patient had Kotlow's Class I ankyloglossia with tongue protrusion of 12 mm [Figure 1]. Following an initial examination and treatment planning discussion, the patient underwent nonsurgical therapy including scaling and root planing with oral hygiene instruction followed by re-evaluation. Written informed consent was taken from patient's parents and a treatment plan of partial frenectomy with laser was made. A complete hemogram depicted values within normal limits.
Figure 1: Preoperative view showing lingual frenum measuring 12 mm

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The patient was asked to do a presurgical mouth rinse using 2 ml of 0.2% chlorhexidine solution, and 5% povidone-iodine solution (Betadine) was used to perform extraoral antisepsis. Topical anesthetic was applied to the underside of the tongue and local anesthetic infiltration using 2% lignocaine with adrenaline 1:200,000 was administered into the frenum area. Safety measures were taken for operator, patient, and assistant by wearing the recommended laser protective eyewear. High-speed suction and clinical masks were used to prevent infection from the laser plume. Diode laser (iLase™) emitting 940 nm was used for frenectomy where preset value was adjusted: power of 2.00 W, pulsed contact mode, continuous pulse duration, and pulse interval of 1.00 ms. Blunt end to the probe was used to check for the objective symptoms. After the area was anesthetized, the incision was carried out using bendable laser tip with diameter of 300 μm [Figure 2]. The intervening lingual frenum was released from its apex to the base in a brushing stroke. After excision, the surgical site was wiped off with cotton pellet soaked in normal saline. The entire procedure was painless with no bleeding and lesser intraoperative time. Thus, there was no need for sutures.
Figure 2: Intraoperative view showing initiation of laser tip for the incision

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Postsurgical instructions were given with prescription of analgesic (Ibuprofen 200 mg, if needed) and warm saline rinse (3–4 times/day for 2 weeks). To minimize traumatic injury to the wound, mechanical tooth cleaning was restricted to the surgical site for the 1st week. The patient was also advised some exercises: (a) to stretch the tongue upward and downward, (b) to open the mouth widely and touch the front teeth with the tongue, and (c) to shut the mouth and move the tongue into left and right cheek for 3–5 min, once or twice daily for 3 or 4 weeks postoperatively. The patient was recalled after 2 weeks, 1 month, and 5 months postoperatively for revaluation.

The postoperative follow-up at 2 weeks showed improved tongue protrusion [Figure 3] and phonetics of the patient. The patient had less postoperative pain and discomfort. After 5 months postoperatively, tongue protrusion showed measurement of about 20 mm in length [Figure 4].
Figure 3: Postoperative view after 2 weeks

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Figure 4: Postoperative view after 5 months showing lingual frenum measuring >15 mm

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  Discussion Top


Ankyloglossia is a rare congenital anomaly which occurs due to the failure in cellular degeneration leading to much longer anchorage between tongue and floor of the mouth.[3] Most often, ankyloglossia is seen as an isolated finding in an otherwise normal child. Segal et al.[4] considered the effectiveness of frenectomy in treating ankyloglossia. In the present case report, laser was opted for frenectomy as it was considered safe and minimally invasive procedure. Reddy et al.[5] in their case series indicated that laser provides better patient perception than scalpel technique for lingual frenectomy. Iyer and Sudarsa[6] and Bader[7] also highlighted the advantages of lasers for lingual frenectomy. Histologically, laser-created wounds heal more quickly and produce less scar tissue than conventional scalpel surgery,[8] although contrary evidence also exists.[9],[10] The hemostatic effect of laser overall and as seen in the present case can be due to sealing of the capillaries by protein denaturation and stimulation of clotting factor VIII production which results in improved hemostasis and visualization of surgical site which can be left without sutures.[11] In addition, sterilization of wound by laser reduces the need for postoperative care and antibiotics.[12]

The patient was advised to perform postoperative exercise intended to develop new muscle movements to avoid reunion and encouraging free movement of tongue. Thus, in the postoperative follow-up, improved tongue protrusion and phonetics was appreciated with better patient perception, supported by Kishore et al. and[13] Prabhu et al.[14]

Laser frenectomy is a promising technique in treating ankyloglossia. Although laser has many advantages, it requires some precautions during and after irradiation such as using protective eyewear, high-speed evacuation, and a properly trained operator as an important part of laser safety.

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.
Wallace AF. Tongue tie. Lancet 1963;2:377-8.  Back to cited text no. 1
    
2.
Kotlow LA. Ankyloglossia (tongue-tie): A diagnostic and treatment quandary. Quintessence Int 1999;30:259-62.  Back to cited text no. 2
    
3.
Verdine VA, Khan R. Management of ankyloglossia – Case reports. IOSR J Dent Med Sci 2013;6:31-3.  Back to cited text no. 3
    
4.
Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia: Methodologic review. Can Fam Physician 2007;53:1027-33.  Back to cited text no. 4
    
5.
Reddy NR, Marudhappan Y, Devi R, Narang S. Clipping the (tongue) tie. J Indian Soc Periodontol 2014;18:395-8.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Iyer VH, Sudarsa S. A comprehensive treatment protocol for lingual frenectomy with combination of lasers and speech therapy: Two case reports. Int J Laser Dent 2015;5:12-21.  Back to cited text no. 6
    
7.
Bader HI. Use of lasers in periodontics. Dent Clin North Am 2000;44:779-91.  Back to cited text no. 7
    
8.
Fisher SE, Frame JW, Browne RM, Tranter RM. A comparative histological study of wound healing following CO2 laser and conventional surgical excision of canine buccal mucosa. Arch Oral Biol 1983;28:287-91.  Back to cited text no. 8
    
9.
Buell BR, Schuller DE. Comparison of tensile strength in CO2 laser and scalpel skin incisions. Arch Otolaryngol 1983;109:465-7.  Back to cited text no. 9
    
10.
White JM, Goodis HE, Rose CL. Use of the pulsed Nd:YAG laser for intraoral soft tissue surgery. Lasers Surg Med 1991;11:455-61.  Back to cited text no. 10
    
11.
Pirnat S. Versatility of an 810 nm diode laser in dentistry: An overview. J Laser Health Acad 2007;4:1-9.  Back to cited text no. 11
    
12.
Kotlow LA. Lasers in pediatric dentistry. Dent Clin North Am 2004;48:889-922, vii.  Back to cited text no. 12
    
13.
Kishore A, Srivastava V, Mahendra AV. Ankyloglossia or tongue tie-a case report. J Dent Med Sci (IOSR-JDMS) 2014;13:52-4.  Back to cited text no. 13
    
14.
Prabhu M, Sharath KS, Thomas B, Shenoy SB, Shetty S. Treatment of ankyloglossia using diode laser-a case report. Nitte Univ J Health Sci 2014;4:110.  Back to cited text no. 14
    


    Figures

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



 

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