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Verma M, Khan MA, Haque AU, Fiza Mustaqueem S. Diode Laser Frenectomy: A Torch of Freedom for Ankyloglossia. Cureus 2024; 16:e58319. [PMID: 38752065 PMCID: PMC11094657 DOI: 10.7759/cureus.58319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/18/2024] Open
Abstract
Ankyloglossia, also known as tongue-tie, is a rare congenital anomaly of the oral cavity that not only causes difficulties in breastfeeding and teeth cleaning but also causes difficulty in speech articulation. Our patient faced difficulty in freely moving his tongue because of the short lingual frenulum wherein laser lingual frenectomy was indicated. The patient was treated successfully with a soft tissue diode laser having a wavelength of 445 nanometers. The use of a low-wavelength diode laser becomes relatively complimentary to standard scalpel surgery because of patient consolation, offers a blood-free area, reduces inflammation and edema, and is less damaging to thermal tissues.
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Affiliation(s)
- Manisha Verma
- Department of Periodontology, King George's Medical University, Lucknow, IND
| | | | - Aehad Ul Haque
- Department of Periodontology, King George's Medical University, Lucknow, IND
| | - Syed Fiza Mustaqueem
- Department of Pathology, Integral Institute of Medical Sciences & Research, Lucknow, IND
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Dhadse PV, Patil RT, Salian SS, Oza RR, Punse SD. Laser-Assisted Lingual Frenectomy: A Case Report. Cureus 2024; 16:e59412. [PMID: 38826594 PMCID: PMC11139779 DOI: 10.7759/cureus.59412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
A lingual frenectomy is a surgical procedure aimed at addressing "tongue-tie" or ankyloglossia, where a strip of tissue restricting tongue movement is removed. Typically, this strip extends from the bottom of the mouth to the underside of the tongue. The procedure, often performed using a diode laser, offers several advantages including simplicity and safety for patients. It can significantly improve speech articulation and eating for individuals with ankyloglossia. This case report highlights the successful treatment of a female patient experiencing speech difficulties with diode laser therapy for tongue-tie.
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Affiliation(s)
- Prasad V Dhadse
- Department of Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Ruchita T Patil
- Department of Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Shrishti S Salian
- Department of Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Ranu R Oza
- Department of Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sanehi D Punse
- Department of Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Frezza A, Ezeddine F, Zuccon A, Gracco A, Bruno G, De Stefani A. Treatment of Ankyloglossia: A Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1808. [PMID: 38002899 PMCID: PMC10670877 DOI: 10.3390/children10111808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
AIM The aim of this narrative review is to analyze and compare the current scientific evidence regarding the diagnosis and treatment of hypertrophic lingual frenulum in preschool and school-age children. The treatments considered in this review are traditional surgical therapy, laser-assisted surgical therapy, and functional rehabilitation therapy. MATERIALS AND METHODS A comprehensive literature review was conducted using the PubMed and PubMed Central search engines, considering articles published in the English language between 1 January 2000 and 30 June 2022. The bibliographic search was performed using the following keywords as search strings: "lingual", "frenulectomy", "frenulotomy", "frenulum", "ankyloglossia", and "laser." RESULTS A total of 14 articles were included in this review, including four prospective observational studies, one case-control study, three cross-sectional studies, four retrospective studies, and one randomized controlled trial. The data extracted from each article are summarized in a table. CONCLUSIONS In the literature, there are still limited studies regarding the treatment of hypertrophic frenulum. No common indications for the treatment of ankyloglossia and universally used classification for lingual frenulum were found. Currently, clinicians prefer the use of a diode laser for treatment. This method offers several advantages over the use of a scalpel blade. Many studies agree on the usefulness of providing patients with myofunctional rehabilitation to improve lingual mobility, both prior to surgical therapy and in the postoperative period.
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Affiliation(s)
- Alessandro Frezza
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
| | - Fatima Ezeddine
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
| | - Andrea Zuccon
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
| | - Antonio Gracco
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
| | - Giovanni Bruno
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
- Department of Industrial Engineering, University of Roma Tor Vergata, 00133 Roma, Italy
| | - Alberto De Stefani
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
- Department of Pharmacological Sciences, University of Padova, 35122 Padova, Italy
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Yu C, Li QQ, Zhang RZ, Chen SL, Xia FF, Zhou Z. Effects of different surgical treatments on children with ankyloglossia: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e065653. [PMID: 36600360 PMCID: PMC9730349 DOI: 10.1136/bmjopen-2022-065653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Ankyloglossia is a situation where the tongue tip cannot go beyond the mandibular incisor because the frenulum linguae is short. It could affect children's health by interfering with their ability to talk, breast feeding and dental development. The most effective measure to control ankyloglossia is the surgical method. However, which surgical procedure is the best one is still controversial. Thus, this protocol aims to assess the effectiveness of different surgical interventions in children with ankyloglossia. METHODS AND ANALYSIS PubMed, EMBASE, Cochrane Library, Web of Science and OVID will be searched for relevant information from inception to 31 May 2022. Observational studies in English that investigate the association between surgical methods and ankyloglossia will be included in this protocol. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. The Critical Appraisal Checklist for Analytical Cross-Sectional Studies and the Newcastle-Ottawa Quality Assessment Scale for longitudinal studies will be used to assess the included studies. The improvement of breast feeding and nipple pain will be the primary outcome. STATA V.15.1 will do the statistical analysis in the meta-analysis. Subgroup and meta-regression will be carried out based on the characteristics of included studies. ETHICS AND DISSEMINATION This systematic review and meta-analysis will summarise relevant information on the effects of different surgical treatments on patients with ankyloglossia. The results will be disseminated through peer-reviewed publications. The data included in this study will be extracted from the published original studies. Thus, ethical approval and informed consent will not be required. PROSPERO REGISTRATION NUMBER CRD42022323350.
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Affiliation(s)
- Chongqing Yu
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | - Qi-Qi Li
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | - Ruo-Zhen Zhang
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | | | - Fei-Fei Xia
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | - Zheng Zhou
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
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Muacevic A, Adler JR. Labial Frenotomy for Symptomatic Isolated Upper Lip Tie. Cureus 2022; 14:e32755. [PMID: 36686132 PMCID: PMC9851728 DOI: 10.7759/cureus.32755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The benefits and challenges of successful breastfeeding for both mother and child have been well-established in the literature. While ankyloglossia, or tongue tie, alone or in combination with upper lip tie has been the focus of several previous studies, very few have directly addressed isolated symptomatic upper lip tie and the role of surgical correction for breastfeeding difficulties. MATERIALS AND METHODS Seven infants with isolated upper lip tie and breastfeeding difficulty were taken to the operating room for labial frenotomy. These infants were assessed at their follow-up visits for their degree of weight gain since their procedure. Their mothers were surveyed regarding their experiences with breastfeeding since the frenotomy was performed. RESULTS In this article, we present seven infants with isolated upper lip tie and breastfeeding difficulty who were treated with labial frenotomy. Subsequently, these infants demonstrated improved weight gain, and all mothers reported increased ease of breastfeeding. CONCLUSION These findings implicate lip tie as an underrecognized cause of breastfeeding difficulty and suggest that labial frenotomy is an effective treatment in these patients. Larger-scale randomized controlled studies are necessary to further evaluate this topic.
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Murias I, Grzech-Leśniak K, Murias A, Walicka-Cupryś K, Dominiak M, Golob Deeb J, Matys J. Efficacy of Various Laser Wavelengths in the Surgical Treatment of Ankyloglossia: A Systematic Review. Life (Basel) 2022; 12:life12040558. [PMID: 35455049 PMCID: PMC9031639 DOI: 10.3390/life12040558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Ankyloglossia, commonly known as tongue-tie, is the most common disorder of tongue morphology characterized by aberrant attachment of the lingual frenum. This study aimed to provide a comprehensive literature review and evaluate the effectiveness of various laser wavelengths in the surgical treatment of patients with ankyloglossia. An electronic screening of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted on 8 November 2021. The following search terms were used to review the available data on the subject of interest: (ankyloglossia OR tongue tie OR short lingual frenulum OR lingual frenectomy OR lingual frenulectomy OR lingual frenotomy OR lingual frenulotomy) AND laser. The use of lasers in ankyloglossia treatment resulted in shorter procedure time, reduced indications for general anesthesia, reduced administration of postoperative analgesics, fewer sutures or none needed, reduced postoperative bleeding, and improved healing. Despite many advantages, this method has its clinical limitations: it requires the use of expensive equipment; well-trained personnel familiar with lasers; and personal protective equipment for the patient, caregiver, operator, and assistant. The laser procedure does not eliminate the need for myofunctional exercises and work with a speech therapist.
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Affiliation(s)
- Iwona Murias
- EMDOLA, Wroclaw Medical University, 50-425 Wroclaw, Poland;
| | - Kinga Grzech-Leśniak
- Laser Laboratory, Oral Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland; (M.D.); (J.M.)
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA;
- Correspondence:
| | - Anna Murias
- Faculty of Medicine, Pavel Jozef Šafárik University, Trieda SNP 1, 040 11 Košice, Slovakia;
| | - Katarzyna Walicka-Cupryś
- Institute of Health Sciences, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland;
| | - Marzena Dominiak
- Laser Laboratory, Oral Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland; (M.D.); (J.M.)
| | - Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Jacek Matys
- Laser Laboratory, Oral Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland; (M.D.); (J.M.)
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The Efficacy of Lingual Laser Frenectomy in Pediatric OSAS: A Randomized Double-Blinded and Controlled Clinical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116112. [PMID: 34204017 PMCID: PMC8200995 DOI: 10.3390/ijerph18116112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 01/03/2023]
Abstract
This randomized, double-blind and controlled clinical trial investigates how a diode laser lingual frenectomy can improve obstructive sleep apnea syndrome (OSAS) in pediatric patients. Background: Several authors have shown that a short lingual frenulum causes a reduction in incoming air flow and the relationship between OSAS and a short lingual frenulum. Methods: Thirty-two pediatric patients were equally randomly divided into a Study Group (SG) and a Control Group (CG). On each SG patient a polysomnography 1 (PSG1) and a lingual frenectomy were performed using a diode laser via Doctor Smile Wiser technology, power 7 W. After three months, a new polysomnography (PSG2) was performed to evaluate the lingual frenectomy efficacy in pediatric patients. The pain was assessed by a numerical rating scale (NRS) before and after surgery. The CG followed the same protocol without a lingual frenectomy but myofunctional and speech therapy were conducted to qualitatively and quantitatively improve the lingual functionality. In the SG, eight subjects (50%) had severe OSAS and eight had moderate (50%) while in the CG, three subjects had severe OSAS (18.8%) and thirteen had moderate (81.2%). Results: In the SG, 93.8% were classified as mild OSAS and 6.2% as moderate. In contrast, in the CG, 18.75% were classified as mild OSAS, 62.5% as moderate and 18.75% as severe. Conclusion: The study demonstrates how a lingual laser frenectomy can improve OSAS in pediatric patients.
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Khan U, MacPherson J, Bezuhly M, Hong P. Comparison of Frenotomy Techniques for the Treatment of Ankyloglossia in Children: A Systematic Review. Otolaryngol Head Neck Surg 2020; 163:428-443. [DOI: 10.1177/0194599820917619] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective To compare the effectiveness of conventional (CF), laser (LF), and Z-plasty (ZF) frenotomies for the treatment of ankyloglossia in the pediatric population. Data Sources A comprehensive search of PUBMED, EMBASE, and COCHRANE databases was performed. Review Methods Relevant articles were independently assessed by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results Thirty-five articles assessing CF (27 articles), LF (4 articles), ZF (3 articles), and/or rhomboid plasty frenotomy (1 article) were included. A high level of outcome heterogeneity prevented pooling of data. All 7 randomized controlled trials (RCTs) were of low quality. Both CF (5 articles with 589 patients) and LF (2 articles with 78 patients) were independently shown to reduce maternal nipple pain on a visual analog or numeric rating scale. There were reports of improvement with breastfeeding outcomes as assessed on validated assessment tools for 88% (7/8) of CF articles (588 patients) and 2 LF articles (78 patients). ZF improved breastfeeding outcomes on subjective maternal reports (1 article with 18 infants) only. One RCT with a high risk of bias concluded greater speech articulation improvements with ZF compared to CF. Only minor adverse events were reported for all frenotomy techniques. Conclusions Current literature does not demonstrate a clear advantage for one frenotomy technique when managing children with ankyloglossia. Recommendations for future research are provided to overcome the methodological shortcomings in the literature. We conclude that all frenotomy techniques are safe and effective for treating symptomatic ankyloglossia.
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Affiliation(s)
- Usman Khan
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jake MacPherson
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Paul Hong
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
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Nammour S. Laser-Assisted Tongue-Tie Frenectomy for Orthodontic Purpose: To Suture or Not to Suture? PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:381-382. [PMID: 31180259 DOI: 10.1089/photob.2019.4647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Samir Nammour
- Department of Dental Sciences, Faculty of Medicine, University of Liege, Liege, Belgium
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Mills N, Pransky SM, Geddes DT, Mirjalili SA. What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum. Clin Anat 2019; 32:749-761. [PMID: 30701608 PMCID: PMC6850428 DOI: 10.1002/ca.23343] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 01/28/2023]
Abstract
Surgical release of the lingual frenulum (frenotomy) has become an increasingly common procedure, performed from birth through to adulthood. Surprisingly, detailed anatomy of the in‐situ lingual frenulum has never been described, and no anatomical basis has been proposed for the individual variability in frenulum morphology. The lingual frenulum is frequently referred to as a “cord” or “submucosal band” of connective tissue, yet there is no evidence to support this anatomical construct. This paper aims to describe the anatomy of the in‐situ lingual frenulum and its relationship to floor of mouth structures. Fresh tissue microdissection of the lingual frenulum and floor of mouth was performed on nine adult cadavers with photo‐documentation and description of findings. The lingual frenulum is a dynamic structure, formed by a midline fold in a layer of fascia that inserts around the inner arc of the mandible, forming a diaphragm‐like structure across the floor of mouth. This fascia is located immediately beneath the oral mucosa, fusing centrally with the connective tissue on the tongue's ventral surface. The sublingual glands and submandibular ducts are enveloped by the fascial layer and anterior genioglossus fibers are suspended beneath it. Lingual nerve branches are located superficially on the ventral surface of the tongue, immediately deep to the fascia. The lingual frenulum is not a discrete midline structure. It is formed by dynamic elevation of a midline fold in the floor of mouth fascia. With this study, the clinical concept of ankyloglossia and its surgical management warrant revision. Clin. Anat. 32:749–761, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
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Affiliation(s)
- Nikki Mills
- Department of Paediatric OtolaryngologyStarship Children's HospitalAucklandNew Zealand
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Seth M. Pransky
- Pediatric OtolaryngologistPediatric Specialty PartnersSan DiegoCalifornia
| | - Donna T. Geddes
- School of Medicine and PharmacologyUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Seyed Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
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