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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 9  |  Issue : 2  |  Page : 104-106

Diode laser: An alternative treatment modality for ankyloglossia


Department of Periodontics, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India

Date of Web Publication26-Nov-2015

Correspondence Address:
Vijayendra Kumar Jain
Jain, A-4, AWHO Complex, Bhupinder Vihar, Scheme No. 78, Indore - 452 010, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-2868.158463

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  Abstract 


Ankyloglossia or tongue-tie refers to an abnormally short lingual frenulum. Ankyloglossia is a recognized but poorly defined condition and has been reported to cause feeding difficulties, dysarthria, dyspnea, and social or mechanical problems in childhood and adolescence. This article reports a simple, safe, and effective way for management of ankyloglossia associated with restricted movement of the tongue. The treatment involved a diode laser for removal of the lingual frenum, which healed uneventfully. A marked improvement in the movement of the tongue was observed at follow-up visits in the treated case.

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


How to cite this article:
Jain VK, Jaiswal GR. Diode laser: An alternative treatment modality for ankyloglossia. J Dent Lasers 2015;9:104-6

How to cite this URL:
Jain VK, Jaiswal GR. Diode laser: An alternative treatment modality for ankyloglossia. J Dent Lasers [serial online] 2015 [cited 2021 Dec 5];9:104-6. Available from: https://www.jdentlasers.org/text.asp?2015/9/2/104/158463




  Introduction Top


Ankyloglossia, also known as tongue-tie, is a congenital anomaly characterized by an abnormally short lingual frenulum.[1] Clinically, the term has been used to describe different situations, such as a tongue that is fused to the floor of the mouth as well as a tongue with impaired mobility due to a short and thick lingual frenulum.[2]

There is continuing controversy over the diagnostic criteria and treatment of ankyloglossia.[3] Several studies establish diagnostic criteria based on the length of the lingual frenulum,[4] amplitude of tongue movement,[5],[6],[7],[8] heart-shaped look when the tongue is protruded and thickness of the fibrous membrane.[9],[10],[11]

Based on the length of the free tongue,[12] ankyloglossia can be classified as follows:

  • Clinically acceptable: Normal >16 mm
  • 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: Less than 3 mm.


In children, ankyloglossia can lead to breastfeeding difficulties, speech disorders, poor oral hygiene and bullying during childhood and adolescence. Nowadays, several surgical techniques have been described to correct an abnormal frenulum.[6],[9],[11],[13],[14],[15],[16]

Laser has several advantages over conventional surgical treatment modalities which include bloodless operating field, no postoperative infection or pain and no suturing required. The case report discusses successful management of ankyloglossia or tongue tie with diode laser.


  Case Report Top


A 12-year-old male patient reported with a chief complaint of not being able to talk clearly and difficulty in protruding his tongue completely. Medical history was Non-contributory. On oral examination, the patient was found to have short lingual frenum with restricted tongue movements. It was observed that when the mouth was open, it was impossible for the patient to protrude his tongue. This clinical condition was diagnosed as Class IV ankyloglossia according to kotlows classification [Figure 1] and [Figure 2].
Figure 1: Preoperative protrusion of tongue

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Figure 2: Preoperative - lingual frenum seen

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Treatment

Frenectomy of the lingual frenum was planned using a 980 nm diode laser [Figure 3]. After obtaining informed consent, topical anesthetic was applied to the underside of the tongue and local anesthetic infiltration was administered into the frenum area. After the anesthesia had been found to be effective, tongue was elevated using a clamp to stabilize it. As the frenum became prominent, the diode laser which was activated at 2 W in continuous mode was applied using initiated tip of 300 µm in contact mode from the apex of the frenum to the base in a brushing stroke thereby cutting the frenum. The ablated tissue was 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 4] and [Figure 5]. No bleeding was observed, and no suturing was done. Patient was prescribed analgesics and postoperative exercises and reviewed after 1-week [Figure 6]. Healing was uneventful. Patient reported increased tongue mobility following surgery and was at ease.
Figure 3: 980 nm diode laser

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Figure 4: Immediate postoperative protrusion of tongue

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Figure 5: Immediate postoperative protrusion of tongue

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Figure 6: One-week postoperative protrusion of tongue

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  Discussion Top


Diode lasers can be used in continuous wave or gated-pulse modes in contact or out of contact with the tissue. The benefits of using laser in oral surgical procedures are significant for the clinician as well as the patient. Laser light is monochromatic, coherent and collimated therefore it delivers a precise burst of energy to the targeted area. There is more efficient incision of the tissues by laser when compared to the scalpel, laser generates complete vaporization and coagulates the blood vessels. Laser has a hemostatic effect that eliminates excessive bleeding which creates clean surgical field allowing increased precision and accuracy and greatly improving visualization of surgical site. Laser wound causes less bleeding due to sealing of capillaries by protein denaturation and stimulation of clotting factor VII. The thermal effect of laser seals the capillaries and lymphatics which reduces the postoperative bleeding and edema.[17] Because of improved healing and hemostasis laser wounds can often be left without sutures. Laser assisted frenectomy is believed to provide better postoperative perception of pain and function than with the scalpel technique.[18] Laser assisted lingual frenectomy is easy, showing excellent precision and less discomfort compared to the conventional technique. High level of sterilization is maintained in diode treatment which reduces the need for postoperative care and antibiotics.


  Conclusion Top


Ankyloglossia or tongue-tie is a congenital condition for which treatment can be made simple and safe. In the present case report, lingual frenectomy was done by diode laser technique which provided the practical benefit to the patient by reducing bleeding, increasing asepsis, decreasing operative and postoperative pain, swelling and no requirement of suture.

 
  References Top

1.
Messner AH, Lalakea ML, Aby J, Macmahon J, Bair E. Ankyloglossia: Incidence and associated feeding difficulties. Arch Otolaryngol Head Neck Surg 2000;126:36-9.  Back to cited text no. 1
    
2.
Suter VG, Bornstein MM. Ankyloglossia: Facts and myths in diagnosis and treatment. J Periodontol 2009;80:1204-19.  Back to cited text no. 2
    
3.
Messner AH, Lalakea ML. Ankyloglossia: Controversies in management. Int J Pediatr Otorhinolaryngol 2000;54:123-31.  Back to cited text no. 3
    
4.
Griffiths DM. Do tongue ties affect breastfeeding? J Hum Lact 2004;20:409-14.  Back to cited text no. 4
[PUBMED]    
5.
Fleiss PM, Burger M, Ramkumar H, Carrington P. Ankyloglossia: A cause of breastfeeding problems? J Hum Lact 1990;6:128-9.  Back to cited text no. 5
[PUBMED]    
6.
Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005;41:246-50.  Back to cited text no. 6
    
7.
Jorgenson RJ, Shapiro SD, Salinas CF, Levin LS. Intraoral findings and anomalies in neonates. Pediatrics 1982;69:577-82.  Back to cited text no. 7
[PUBMED]    
8.
Marmet C, Shell E, Marmet R. Neonatal frenotomy may be necessary to correct breastfeeding problems. J Hum Lact 1990;6:117-21.  Back to cited text no. 8
[PUBMED]    
9.
Chu MW, Bloom DC. Posterior ankyloglossia: A case report. Int J Pediatr Otorhinolaryngol 2009;73:881-3.  Back to cited text no. 9
    
10.
Harris EF, Friend GW, Tolley EA. Enhanced prevalence of ankyloglossia with maternal cocaine use. Cleft Palate Craniofac J 1992;29:72-6.  Back to cited text no. 10
    
11.
Hong P, Lago D, Seargeant J, Pellman L, Magit AE, Pransky SM. Defining ankyloglossia: A case series of anterior and posterior tongue ties. Int J Pediatr Otorhinolaryngol 2010;74:1003-6.  Back to cited text no. 11
    
12.
Kotlow LA. Ankyloglossia (tongue-tie): A diagnostic and treatment quandary. Quintessence Int 1999;30:259-62.  Back to cited text no. 12
    
13.
Aras MH, Göregen M, Güngörmüs 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. 13
    
14.
Heller J, Gabbay J, O'Hara C, Heller M, Bradley JP. Improved ankyloglossia correction with four-flap Z-frenuloplasty. Ann Plast Surg 2005;54:623-8.  Back to cited text no. 14
    
15.
Manfro AR, Manfro R, Bortoluzzi MC. Surgical treatment of ankyloglossia in babies – Case report. Int J Oral Maxillofac Surg 2010;39:1130-2.  Back to cited text no. 15
    
16.
Puthussery FJ, Shekar K, Gulati A, Downie IP. Use of carbon dioxide laser in lingual frenectomy. Br J Oral Maxillofac Surg 2011;49:580-1.  Back to cited text no. 16
    
17.
Denonvillers M. Blepharoplastie. Bull Soc Chir Paris;7:1856-7.  Back to cited text no. 17
    
18.
Haytac MC, Ozcelik O. Evaluation of patient perceptions after frenectomy operations: A comparison of carbon dioxide laser and scalpel techniques. J Periodontol 2006;77:1815-9.  Back to cited text no. 18
    


    Figures

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



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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