|Year : 2012 | Volume
| Issue : 3 | Page : 215-217
Management of ankyloglossia by diode laser
Snophia Suresh, Uma Sudhakar, Satyanarayana Merugu, Ranjit Kumar
Department of Periodontics, Thaimoogambigai Dental College, Golden George Nagar, Chennai, India
|Date of Web Publication||11-Jun-2013|
Department of Periodontics, Thaimoogambigai Dental College, Golden George Nagar, Chennai
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Frenum is a fold of tissue or muscle connecting the lips, cheek, or tongue to the jawbone. It is also known as frenulum, frenulums, frenula, frenums, or frena. Ankyloglossia, commonly known as tongue tie, is a congenital anomaly characterized by an abnormally short/tight lingual frenulum, which restricts mobility of the tongue tip. Though the ankyloglossia or tongue tie is not a serious manifestation, it may lead to a host of problems including infant feeding difficulties, speech disorders, and various mechanical and social issues related to the inability of the tongue to protrude. Lingual frenectomy is advised for the management of ankyloglossia. The present paper discusses one case of successful management of ankyloglossia or tongue tie with diode laser.
Clinical Relevance to Interdisciplinary Dentistry
- Ankyloglossia is commonly associated with speech problems.
- Tongue tie can be corrected by lingual frenectomy
- The common problem during scalpel frenectomy is excessive bleeding.
- To reduce bleeding during surgery and improve postoperative healing, laser-assisted frenectomy is preferred.
Keywords: Ankyloglossia, diode laser, lingual frenectomy, tongue tie
|How to cite this article:|
Suresh S, Sudhakar U, Merugu S, Kumar R. Management of ankyloglossia by diode laser. J Interdiscip Dentistry 2012;2:215-7
| Introduction|| |
The tongue is an accessory organ of importance in deglutition, mastication, and speech. It also exerts influence on dental occlusion, growth, and facial form. Tongue tie or ankyloglossia is the abnormal condition affecting the lingual frenum. The term ankyloglossia was used first in the medical literature in 1960s when Wallace defined tongue tie a "a condition in which the tip of the tongue cannot be protruded beyond the lower incisor teeth because of a short frenulum linguae, often containing scar tissue."  Partial ankyloglossia refers to congenital shortness of the lingual frenum or frenal attachment extending to the tip of the tongue, binding the tongue to the base of the tongue and preventing its extension. 
The ankyloglossia can be classified into four classes based on Kotlow's assessment as follows: 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.  In ankyloglossia, due to restricted tongue movements, patients may exhibit speech difficulties in pronunciation of consonants like t, d, n, and l, and it is difficult to roll a "r." Ankyloglossia has also been associated with problems with breast feeding among neonates, malocclusion, and gingival recession.  Diode lasers have several advantages when compared to conventional surgeries and electrosurgery units for frenectomies. The present case report describes the diode laser-assisted lingual frenectomy procedure.
| Case Report|| |
A 22-year-old male reported in the Department of Periodontics, Thaimoogambigai Dental College, Chennai, with a complaint of difficulty in speech since birth. On intraoral examination, it was found that the individual had partial ankyloglossia [Figure 1]a and was classified as class III according to Kotlow's assessment and was able to protrude the tongue up to the lower lip. Lingual frenectomy by soft tissue laser was planned for the patient after informed consent was taken from him.
|Figure 1: Lingual frenectomy using diode laser (a) preoperative view showing ankyloglossia, (b) diode laser unit, (c) lingual frenum excised, (d) postoperative view after 1 month, (e) postoperative view after 3 months|
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After application of topical anesthesia, few drops of lignocaine were injected in the frenum. Diode laser (830 nm) was used for the frenectomy procedure [Figure 1]b. After stripping the fiber-optic wire tip, the tip was initiated by firing it into a piece of cork at 1.4 W in a continuous mode. An initiated tip of 300 μm was used with an average power of 1.37 W in a pulsed mode. The diode laser was applied in a contact mode with focused beam for excision of the tissue. The tip of the laser was moved from the apex of the frenum to the base in a brushing stroke cutting the frenum. The ablated tissue was continuously mopped using wet gauze piece. This takes care of the charred tissue and prevents excessive thermal damage to the underlying soft tissue. The attachment of frenum to the alveolar ridge was also excised to prevent tension on the gingiva [Figure 1]c. Vitamin E solution was applied to the wound site. Protrusive tongue movement was checked. No suturing was done, and the patient was prescribed analgesics and reviewed after 1 week and healing was satisfactory. Patient was again examined after 1 and 3 months, he reported increase in tongue mobility following surgery and healing was satisfactory [Figure 1]d and e The speech articulation was improved following speech therapy.
| Discussion|| |
Diode lasers are compact and portable in design, with efficient and reliable benefits for use in soft tissue oral surgical procedure. Laser light is monochromatic, coherent, and collimated; therefore, it delivers a precise burst of energy to the targeted area. Histologically, laser wounds have been found to contain significantly lower number of myofibroblasts.  This results in less wound contraction and scarring, and ultimately improved healing. Laser-assisted frenectomy provides better postoperative perception of pain and function than with the scalpel technique. 
Although the conventional surgical frenectomies produce good result, they have their own disadvantages compared to laser-assisted frenectomy. Suturing on the ventral surface of tongue at times can cause blockage of Wharton's duct. Surgical manipulations on the ventral part of tongue may also damage the lingual nerve and cause numbness of the tongue tip.
Laser-assisted lingual frenectomy is easy to perform with excellent precision, less discomfort, and short healing time compared to the conventional technique. Patient was comfortable and there was absolutely no bleeding. We used pulsed mode which provides time for the tissue to cool and prevents collateral tissue damage.  The frenum was completely eliminated and could protrude the tongue up to 15 mm. Laser wound results in minimal or no bleeding, which is due to sealing of capillaries by protein denaturation and stimulation of clotting factor VII production. The thermal effect of laser seals the capillaries and lymphatics, which also reduce the postoperative bleeding and edema.  In addition, sterilization of wound by laser reduces the need for postoperative care and antibiotics.
| Conclusion|| |
Ankyloglossia is a relatively harmless condition and the treatment is relatively simple and safe. In the present case report, lingual frenectomy was done by diode laser which provides practical benefit to the patient as it reduces bleeding, postoperative pain, and swelling. In future, patients could be benefited by the laser-assisted surgeries.
| References|| |
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