Tip II Anterior Tongue Tie

Lingual Frenulum Surgery

In the new classification of tongue tie, tongue ties are grouped as type I, II, III according to their location from the tongue to the back and grouped as anterior tongue tie and type IV, classified as posterior tongue tie or submucosal tongue tie.

Type II anteror tongue tie is a type of tongue tie that does not reach the tip of the tongue and causes the tongue to swell in the frontal region when the tongue is lifted upwards.

Due to the inability of the tongue tip to contact the inner surface of the posterior teeth, gum stones and gum disease may appear on the inner surfaces of the posterior teeth.

During the examination, it can also be seen that during the upward movement of the tongue, tongue depression occurs, tongue tongue and tongue tip, which are tense during the lifting of the tongue tip, can be removed in front of the lower lips. During the examination, it can also be seen that the tongue tip can be removed in front of the lower lips.

In patients with type II and type III tongue ties, the tongue tie may be detected later and the effects on speech, oral hygiene and nutrition are less pronounced since the restriction of tongue movements is not as much as Type I tongue tie. Stress when saying certain words may cause the expression of difficulty in speaking during adulthood.

When tongue tie is assessed, manual examination should also be done. While fore-tongue ligaments (Type I, II and III) can be seen; posterior tongue tie can only be understood during manual examination.

In patients with Type II anterior tongue tie, tongue tie operation is usually sufficient for treatment. The procedure can be performed under local anesthesia and in office conditions in infants and young adults aged 6 months.

Techniques for tongue tie release

When it comes to releasing a tongue tie, several techniques can be employed by healthcare professionals. The choice of technique depends on various factors, including the severity of the tongue tie, the age of the patient, and the healthcare provider's preference and expertise. Here are some common techniques used for tongue tie release:

1. Frenotomy: Frenotomy is a simple and minimally invasive technique commonly used for infants with a mild to moderate tongue tie. The procedure is typically performed without anesthesia. The healthcare provider uses a sterile pair of scissors or a laser to make a precise cut or snip in the frenulum, releasing the tongue tie. The procedure is quick, and minimal bleeding is expected.

2. Frenuloplasty: Frenuloplasty is a technique employed for more severe tongue ties or when a frenotomy alone may not be sufficient. This procedure is usually performed under local anesthesia. It involves making an incision in the frenulum and then carefully suturing or stitching the edges to create a longer and more flexible frenulum. Frenuloplasty allows for a wider range of tongue movement and is often performed in older children or adults.

3. Laser-assisted frenectomy: Laser technology is sometimes used in tongue tie release procedures. A laser can precisely cut or vaporize the frenulum, minimizing bleeding and reducing the risk of infection. Laser-assisted frenectomy is often preferred in certain cases due to its precision and potential for faster healing. It may require local anesthesia or sedation, depending on the patient's age and the extent of the tongue tie.

4. Functional Lingual Frenuloplasty: This technique is used for tongue ties that are associated with specific functional issues, such as speech difficulties or feeding problems. The procedure aims to not only release the frenulum but also improve tongue function and mobility. The healthcare provider may use a combination of techniques, such as releasing the frenulum and providing guidance and exercises to facilitate proper tongue movement and function.

5. Z-plasty: Z-plasty is a surgical technique that can be employed in cases where the tongue tie is thick or fibrous. It involves making Z-shaped incisions on either side of the frenulum and then repositioning the flaps to create a more flexible and functional frenulum. Z-plasty can help improve tongue movement and reduce the risk of reattachment.

It's important to note that the choice of technique may vary among healthcare providers based on their training, experience, and assessment of the specific tongue tie. The healthcare provider will evaluate the tongue tie, consider the patient's unique circumstances, and recommend the most appropriate technique for optimal results.

After any tongue tie release procedure, it is essential to follow post-operative care instructions provided by the healthcare provider. This may include exercises to promote tongue mobility, wound care, and regular follow-up appointments to monitor healing and address any concerns.

It is advisable to consult with a healthcare professional who specializes in tongue tie release to determine the most suitable technique for your specific situation. They can evaluate the severity of the tongue tie, discuss the potential benefits and risks of each technique, and guide you through the entire process.

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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