Lingual Frenum or TongueTie –
A prominent lingual frenum, attached high on the lingual alvelor ridge, is seen commonly in infants. This causes decreased tongue mobility and the fear of future speech impairment. The lingual frenum becomes less prominent during the first 2-5 years of life. Children in mixed dentition may complain of difficulty moving their tongue. A lingual frenum with high attachment on the alveolus may contribute to gingival inflammation and recession in relation to the central incisors. Lingual frenectomy is performed more commonly for one of the above reasons than for speech articulation problems.
Techniques:
Excision and V-Y Closure
The frenum is cut from the attach menton the alveolar ridge. Then a traction is applied with forceps. Parallel incisions extending along the floor of the mouth and ventral surface of the tongue are made and the band of tissues is removed. Relaxing incisions are then made at a junction of the floor of the mouth and the ventral surface of the tongue converting a straight line defect to a ‘V’. The defect is then closed as ‘Y’ with 4-5 chromic catgut sutures. This process accomplishes excision of the frenum and simultaneous lengthening of the lingual sulcus.
Excision and Z-plasty Closure
An alternative is frenectomy with single or multiple Z-plasties to lengthen the ventral surface of the tongue.Two large triangular flaps are created on the ventral surface of the tongue. The flaps are transposed as ‘Z’ plasty. This improves the tongue’s mobility without endangering the submandibular ducts.
Laser Excision
Tongue Tie may also be corrected using Carbon dioxide laser. Traction is applied to the tongue to identify the frenum. With the laser set at 7watts in the pulsating mode, the frenum is outlined. Then, using a continuous mode, the frenum is excised. Relaxing incisions are made at the junction of the floor of the mouth and the ventral surface of the tongue. Hemostasis is achieved by defocusing the beam and lasering the bed.
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