Management of Tongue-Tie/Ankyloglossia - A Surgical Procedure with Dental Laser

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• Management of Tongue-Tie/Ankyloglossia - A
  Surgical Procedure with Dental Laser
• Introductions
• Tongue-tie (ankyloglossia) is a congenital
  condition that restricts the tongue's range of
  motion. An unusually short, thick or tight band
  of tissue (lingual frenulum) attaches the bottom
  of the tongue's tip to the floor of the mouth,
  causing difficulties in infants to adulthood
  through adolescence. Breast-feeding in infants,
  difficulty while eating, speaking, swallowing
  malocclusion, sleep apnea are few to mention.
• Clinical assessment of tongue tie
• The most common used scales for tongue tie
  assessment are
• Hazelbaker scale
• Koltow scale
• In infants full feeding assessment is also
  required
• Treatment
• Tongue tie treatment depend on severity and is a
  very controversial topic. There are two variants
  of tongue-tie, Anterior and posterior. Posterior
  tongue tie is difficult to detect and treat. The
  lingual frenulum may loosen over time, resolving
  tongue-tie. In other cases,

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Fig.1 - Preoperative Anterior Tongue Tie In the
conventional form of treatment, frenotomy is
simple snap with anesthesia whereas
frenuloplasty require muscle release, suture and
to be done under general anesthesia. Side
effects are bleeding or infection, or damage to
the tongue and salivary glands. Scarring is
possible due to the more extensive nature of the
procedure. However, LASER is effective and
non-invasive procedure. Pioon LASER provide
different wavelengths like 450nm that can be
worked in noncontact mode and 810/980nm in
contact mode. Before LASER irradiation, the
operating staff, assistant and the patient wear
special laser-protective eyeglasses
corresponding to LASER wavelength, highly
reflective instruments or instruments with
mirrored surfaces are avoided and most of the
times only the use of topical anesthesia suffices
for a painless LASER tissue ablation. Plastic or
wooden instruments can be used. Low level LASER
therapy can be given immediately using 660nm
wavelength and at follow-up visits as well for
better and faster wound healing process.
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Fig.2 Immediate Postoperative Anterior Tongue
Tie Surgery by Pioon Laser
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Fig.3 3 Day Post Operative Recall Rationale
behind use of LASER
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LASER ablation has been recognized as a quick
painless and reliable technique. It reduces
chairside time and is bactericidal so no
infection so faster and better healing. As a
result, it causes lesser pain and discomfort to
the patients. Blue dental LASER (450nm) in
non-contact mode allows clean cutting with less
bleeding in adjacent tissues. The study by Da Ali
Jiang et al (2019) demonstrated that a 450-nm
wavelength diode blue LASER is capable to produce
high efficient tissue vaporization and has low
thermal damage to adjacent tissues. Conclusion D
iode Dental LASER is a safe and effective
treatment modality that provides minimal
discomfort to patients with tongue tie. Low level
LASER therapy on day of surgery and in recall
visit help in better patient compliance.
Antibiotics are not required. Analgesics as
required by the patient. Tongue exercises
post-surgery are mandatory to avoid
relapse. Reference Da-Li Jiang et al. A Novel
450-nm Blue Laser System for Surgical
Applications Efficacy of Specific Laser-Tissue.
Lasers Med Sci . 2019 Jun34(4)807-813.
doi 10.1007/s10103-018-2668-5. Epub 2018 Nov
8. By- Dr Neha Pankey MDS Pedodontics Divas in
Laser