Tuesday, May 7, 2013
The patient, a 39-year-old white male presented to us with a complaint of, “My wife says that I mumble.” Upon examination it was clear he had a very high lingual frenum that limited the movement of his tongue (Figs. 1 & 2).
Options to treat this situation include traditional surgery requiring a scalpel and suturing or the use of a dental laser. Diode lasers can produce quite a bit of heat and collateral damage to adjacent delicate tissues, whereas a Nd:YAG laser produces significantly less heat generation and provides good hemostasis.
I find the Erbium lasers, if set appropriately and used waterlessly, cut efficiently with little bleeding or collateral damage. For this case I chose to use the Fotona LightWalker laser because of its significantly higher absorption in water which is its chromophore, as well as its efficient cutting capabilities and the way it facilitates patient comfort.
Fig. 1: Pre-op view of limited tongue mobility.
Fig. 2: Pre-op view of the extreme tongue tie.
Anesthesia was with TAC topical and small amounts of Lidocaine with Epinephrine injected directly in the frenum. The patient’s tongue was held with a 2x2 gauze to expose the frenum. The Er:YAG laser was used with a tipless handpiece with no air or water to ablate the connective tissue in the frenum and release the tongue. When doing this type of procedure, caution must be used around adjacent soft tissue structures. The Nd:YAG laser was used to control any bleeding, which was minimum in this case. It also was used to biostimulate the tissues. No sutures were necessary and patient discomfort was minimal.
The patient had immediate improvement in tongue mobility, extension and speech (Fig. 3). He was given post-operative instructions and exercises to extend his range of motion. When he returned 20 days later, healing was uneventful (Fig. 4) and the patient stated that his wife was happy with his speech improvements and “more.”
Fig. 3: Patient showed improvement immediately post-op.
Fig. 4: 20 days post-op and healing nicely.
Lasers help make this type of treatment significantly less traumatic for both children and adults. With a laser rather than a scalpel, healing is faster and usually uneventful, and there are no sutures to be removed.