A Novel surgical pre-suturing technique for the management of ankyloglossia

Abstract

Ankyloglossia or “tongue-tie” is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort.

Ankyloglossia as an oral functional problem and its surgical management

“…However, several syndromes are associated with this physical finding, including Ehlers-Danlos syndrome, Beckwith-Wiedemann syndrome, Simosa syndrome, X-linked cleft palate, and orofaciodigital syndrome. 1,3,6 Ankyloglossia might be a result of a possible manifestation of mutations in T-box genes or of exposure to teratogenic substances during pregnancy. 2,3 Diagnosis is based on a clinical examination.…”

“…Furthermore, instances of speech difficulty resulting from the limited tongue movements can be checked by vocalizing some letters and words (sounds such as "t", "d", "r", "n", and "l", and words like "ta", "te", time, water, cat, etc.). 3,6 Kotlow classified the ankyloglossia into 4 classes: -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). 8 Several publications have investigated the influence of the tongue and lingual frenulum on maxillofacial anomalies such as mandibular prognathism, maxillary protrusion and anterior open bite.…”

“…There is no sufficient evidence in the literature concerning surgical treatment options for ankyloglossia to favor any of the 3 main techniques. 6,11 In these clinical cases, our 2 patients with tongue-tie were subjected to surgical correction by frenectomy procedure, which is more invasive and difficult to be performed in young children, although the results are more predictable, decreasing the recurrence rate. 12 On the other hand, the use of lasers as an alternative technique in the treatment of ankyloglossia is considered safe and minimally invasive.…”

“…4,5 In children, ankyloglossia can lead to difficulty in breastfeeding, pronunciation disorders, unsatisfactory oral hygiene, bullying during childhood and adolescence, as well as difficulties in sucking or ice-cream licking, kissing and playing wind musical instruments. 2,6 The aim of the present article is to describe 2 clinical cases of ankyloglossia and their successful surgical management with lingual frenectomy, followed by speech therapy for an immediate rehabilitation of the lingual muscles; also, a short literature review is presented.…”

Oral lesions of higher clinical frequency in children – literature review

“…Its diagnosis occurs randomly during the dental visit. This lesion does not require treatment, only hygiene guidelines to avoid accumulation of food causing local irritation 34,35 .…”