Type III Anterior Tongue Tie - Preoperative and Postoperative Examination

Lingual Frenulum Release Surgery - Before and After

According to the tongue tie classification developed by Dr.Kotlow, the tongue ties began to be classified as between 1 and 4 digits. Type I, II, and III are also grouped as anterior tongue tie and type IV posterior tongue tie or submucosal tongue tie.

Type I tongue tie is a type of tongue tie that comes up to the tip of the tongue and restricts the tongue tip to close.

Type II tongue tie is a type of tongue tie that does not reach the tip of the tongue but causes the pit on the tongue when the tongue is lifted up.

Type III tongue tie is a tongue tie type that is lagging behind Type II and does not cause bifurcation at the tip of the tongue. It is usually noticeable in older ages.

Type IV tongue tie is a type of tongue tie that is visible, under the tongue and under the mucosa, which is understood only during manual examination, especially in infants, difficulty in breastfeeding and premature separation from the breast, mixed with shortness of tongue.

A 15-year-old patient was admitted with a complaint of difficulty in some words while talking, and a tongue tie (Type III anterior tongue tie) was found under the tongue under the tongue which did not reach the tongue tip but restricted the tongue tip and lingual frenectomy was performed under local anesthesia.

After the procedure, the tongue tip can be easily lifted upwards (edema on the tongue tip, tips of the seams that can be absorbed under the tongue due to local anesthetic injection).

The video above is an example of a tongue tie treatment performed under local anesthesia in office conditions. I would like to highlight the following information that should be mentioned here.

With just a simple incision, will tongue-tie rights become normal?

Tongue-tie tissue appears in the mother's womb in the first month. So even when the baby is born; The restrictive effects of the tongue tie may have caused effects on the tongue muscles and tongue structure. Especially in tongue ties that can reach the tip of the tongue, bifurcation at the tongue tip, short and wide appearance of the tongue, notching at the tongue tip, prominence of the tongue edges and a cup-shaped appearance in the tongue may occur. When tongue tie cutting is performed after the age of 6, when language development is mostly complete, as in the video above, structural and functional effects cannot be expected to return to normal with just a simple incision. If there are serious limitations and structural changes in the tongue, the tongue tie should be cut and the tongue muscles should be released as soon as possible. After the surgical treatment of tongue tie, myofunctional therapists, oral physiotherapists, speech therapists should evaluate the patient and follow up with suggestions for the normal functioning of the tongue muscles. If the tongue tie cutting procedure is done successfully as soon as the baby is born, these muscle therapies may not be needed.

If the tongue tie is cut, will the shape of the tongue get sharper and get closer to the normal tongue appearance?

When tongue tie is treated early, anatomical negative changes in the tongue and jaw structure are minimized. After tongue and jaw development is completed, it is not expected that these changes will disappear and the tongue and jaw structure will normalize in patients whose tongue tie is cut. The tongue, jaw and mouth work as a shaping muscle organ. In babies, while the lower jaw grows forward due to the tongue sitting on the upper jaw during sleep; the upper jaw grows laterally and forward. In other words, the tongue functions like an expander that enlarges the upper jaw. In addition to jaw problems such as deep and narrow structure in the upper jaw (dome-palate), backward growth in the lower jaw (retrognathia), distance (gap) between the upper and lower jaws, in babies with tongue movement limitation due to a long-term tongue tie; Very different language forms such as short and wide tongue, forked tongue can also occur. In these patients, many different problems such as sleep apnea, jaw problems, neck pain, problems with swallowing, tooth decay and speech problems (articulation problems) may occur.

Is there a need for another surgical procedure after tongue-tie cutting?

The tissue under the tongue is a tissue that heals very quickly, has a high blood supply, and has a mucosal structure that heals from the periphery to the center. After tongue tie is cut, varying amounts of tongue tie reattachment may occur. In this case, it can be seen that the rhombus-shaped wound site turns into a horizontal shape. If the patients' complaints return, a revision tongue tie operation may be required. In order to reduce the possibility of reattachment, exercises that include suturing the wound site together on the vertical axis and stretching the tongue tie in the vertical axis may be recommended.

Link group where you can find detailed information about togue tie on this website >> https://www.ent-istanbul.com/search?q=tongue+tie
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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