Lingval :// How to do Frenectomy (lingual)http:// Dr. Amik Maytesyan. Loading Unsubscribe from Dr. abnormality where the lingual frenulum is abnormally short and tight (posterior operative techniques for frenotomy, frenectomy and frenuloplasty. Anatomy. A lingual frenectomy is a surgical procedure that removes a band of tissue that connects the underside of the tongue with the bottom of the mouth.
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This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented.
Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional.
Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort. Ankyloglossia, also known as tongue-tie, is a congenital anomaly characterized by an abnormally short lingual frenulum Its prevalence is around 4. 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 There is continuing controversy over the diagnostic criteria and treatment of ankyloglossia Several studies establish diagnostic criteria based on the length of the lingual frenulum 7amplitude of tongue movement 5111423heart-shaped look when the tongue is protruded and thickness of the fibrous membrane 29 In children, ankyloglossia can lead to breastfeeding difficulties, speech disorders, poor oral hygiene and bullying during childhood and adolescence During the 18 th century, midwives used to divide the lingual frenulum with their sharp fingernails 10 For over a century, a grooved tablespoon was created specifically to release the tongue-ties 10 Pediatricians used similar devices over decades, but recurrence was common.
Lingual frenectomy – Wikipedia
Nowadays, several surgical techniques have been described to correct an abnormal frenulum 12101222 The following techniques are of particular interest in Pediatric Dentistry: Therefore, the purpose of the present article was to describe a series of clinical cases of ankyloglossia, which were approached by various techniques.
Additionally, information on the indications, contraindications, advantages and disadvantages of the techniques was presented. A two-year-old boy with ankyloglossia was referred to the Clinic of Pediatric Dentistry for management of the oral condition due to speech delay. Intraoral clinical examination showed a heart-shaped tongue during protrusion and a short lingual frenulum with anterior insertion Fig. The frenulum was cut with Goldman Fox scissors, in a single motion, by holding the tongue up towards the palate Fig.
No suture was needed.
Surgical techniques for the treatment of ankyloglossia in children: a case series
Frenotomy in a baby with ankyloglossia. A Heart-shaped tongue during protrusion caused by a short lingual frenulum with anterior insertion.
B Tongue being held up towards the palate and scissors in position to frwnectomy the frenulum. C Frenulum was cut through the white, fascia-like tissue along a line parallel with the tongue. An eight-year-old female with ankyloglossia was referred from a speech frenecromy to undergo frenectomy due to restriction of tongue movement and function. Clinically, the patient presented a thick and short lingual frenulum with anterior insertion Fig.
A silk suture on the tip of the tongue was used for traction. The frenulum was held with a small curved hemostat with the convex curve facing the ventral surface of the tongue Fig. The first incision was made with a 15c blade following the curvature of the hemostat, cutting through the upper aspect of the frenulum Fig. The second incision was made at the lower aspect of the frenulum, fairly close to the floor of the mouth Fig.
The frenulum was then excised, leaving a diamond-shaped wound. The wound margins were undermined with the tips of blunt-ended dissecting scissors Fig.
Tension-free closure was checked through the insertion of the first absorbable vicryl suture at the middle of the wound.
Additional sutures were placed along the tongue base and on the floor of the mouth Fig. The postoperative period was uneventful and the remaining sutures were removed after 7 days Fig. Frenectomy with use of one hemostat. A Thick and short lingual frenulum with anterior insertion. B Restricted central tongue tip elevation caused by abnormal attachment of the base of the tongue.
C Frenulum being held with a small curved hemostat with the convex curve facing the ventral surface of the tongue. D First incision following the curvature of the hemostat, cutting through the upper aspect of the frenulum. E Second incision at the lower aspect of the frenulum.
F Wound edges being dissected with the tips of blunt-ended scissors. G Absorbable sutures placed over the wound. H cClinical aspect of the surgical site on the seventh postoperative day. An eight-year-old male who felt socially embarrassed about his tongue-tie presented for treatment. Clinical examination revealed a short and thick lingual frenulum, thus lingual frenectomy was indicated Fig.
The antisepsis, anesthesia and tongue traction were conducted as previously described. After achieving good anesthesia, two hemostats one curved and the other straight were placed against the tissues over the superior and inferior aspects of the frenulum, respectively, with their tips meeting in the deep aspect near the base of the tongue Fig. Two incisions were made with a 15c blade following the hemostats, cutting through the upper and lower aspects of the frenulum, thus a triangular tissue held with the hemostats was completely removed Fig.
Fiber remnants were excised Fig. After the surgery, the made with a 15c blade from the tip to the base of the tongue following the device Fig. The grooved director was removed and a silk suture was used for tongue traction. The frenulum remaining was excised Fig. Frenectomy with use of two hemostats. A Clinical aspect of the tongue during protrusion.
B Short and tight lingual frenulum. C Frenulum held with two hemostats, with their tips meeting in the deep aspect near the base of the tongue. D Excised triangular tissue held with the hemostats. E Excision of fiber remnants. F Silk sutures placed over the wound. Frenectomy with use of a grooved director. A Heart-shaped tongue during protrusion. B Short lingual frenulum with apical insertion.
C Tongue being raised toward the palate with a grooved director. D Incision from the tip to the base of the tongue following the grooved director.
E Excision of the remaining frenulum. A seven-year-old male was referred to the Clinic of Pediatric Dentistry by a speech therapist due to impaired speech caused by a short lingual frenulum Fig.
The extraoral and intraoral antisepsis, anesthesia of lingual nerve Fig.
The frenulum incision was carried out with diode laser at a wavelength of nm and power of 2 W in non-contact mode, which was applied continuously frdnectomy the central area of the frenulum from the tip ffenectomy the base of the tongue Fig.
Aspiration was not needed except for the vapor produced by diode laser during the cutting. Suture was not performed, and postoperative period was uneventful Fig. A Short lingual frenulum. B Infiltrative anesthesia of the lingual nerve. C Diode laser application to the central area of the frenulum. D Laser application from the tip to the base of the tongue. E Clinical aspect of the surgical site on the fourteenth postoperative day. In the present work, a case series of children diagnosed with ankyloglossia and approached with different surgical techniques was presented.
The choice of the technique was based on appropriate circumstances carefully evaluated preoperatively, which will be further discussed. The exact cause of ankyloglossia is frenectoomy, although it is likely to be due to abnormal development of the mucosa covering the anterior two-thirds of mobile tongue 2. In most of cases, ankyloglossia is seen as an isolated finding in children. However, several syndromes are associated with this physical frebectomy, including ehlers-Danlos syndrome, Beckwith-Wiedemann syndrome, Simosa syndrome, X-linked cleft palate and orofaciodigital syndrome 23freectomy21 Additionally, maternal cocaine use is reported to increase the risk of ankyloglossia to more than threefold 2 After the establishment of diagnosis of ankyloglossia in children, clinicians may struggle with the management of these patients, since there is no consensus on the indication, timing and type of surgical intervention.
Drenectomy examination of lingual frenulum should consider the morphological and functional aspects of the tongue.
The indication of surgery for functional limitations due to ankyloglossia should occur if evaluation shows that function may be improved by surgery Correct diagnosis of ankyloglossia and early intervention are imperative, since several consequences ranging from restriction of tongue movement to impairment of mandibular growth may occur. In nursing mothers, it may cause breastfeeding difficulties, poor milk transfer and nipple damage, resulting in early weaning and low weight gain in babies 422 Speech articulation problems are the most common indications for lingual frenulum surgery in preschool children 17 Frenotomy the clipping of the lingual frenulum is the most indicated technique for babies with ankyloglossia since it is a conservative, simple and quick procedure that may be performed in the dental office settings during initial consultation 12 Babies experience only minimal discomfort and can breastfeed immediately after the procedure, since the lingual frenulum is thin and with few blood vessels, resulting in very little bleeding after the cutting, as seen in the first case presented here.
The limitation of this technique is the possibility of recurrence and the need to perform complementary procedures to release the tongue satisfactorily 1222 Frenectomy corresponds to the complete excision of the frenulum. This procedure is more invasive and difficult to be performed in young children, although the results are more predictable, decreasing the recurrence rate 18 There are no conclusive parameters regarding the timing of frenectomy in the literature 22 However, surgery should be performed before the child develops abnormal swallowing and speech patterns.
When the procedure is performed in older children, they should be referred to a speech therapist in order to reestablish the normal functions of the tongue