Type III Anterior Tongue Tie - Before and After Tongue Tie Release Operation

Lingual Frenectomy

Video description: While speaking fast, type 3 tongue tie was detected in the examination of the patient who had netic impairment in some words. First, a spray containing lidocaine was sprayed on the patient's tongue tie, and then local anesthetic containing adrenaline and lidocaine was injected with an insulin injector. After waiting for a few minutes, the excised area on the tongue tie was marked with the help of a clamp. Using scissors, the triangular tongue tie tissue was cut and removed. In the vertical axis, the wound edges were sutured with self-melting 5/0 rapid vicryl. Bleeding was controlled and the operation was terminated.

After the operation, the patient was informed that there may be numbness at the tip of the tongue, sometimes asymmetrical appearance due to local anesthetic injection for a few days, and that there may be white healing tissue in the incision area for several weeks. It was recommended to avoid extremely hot and spicy foods in the first week. Postfrenectomy tongue exercises were explained in detail in order to normalize tongue movements and increase muscle activity, and the patient was called for control one week later.

Type III tongue tie is a type of tongue tie that is lagging behind Type II and does not cause bifurcation at the tip of the tongue. It is usually noticed at older ages. Decreased clarity during a fast conversation can cause the expression of difficulty in extracting the tongue. Type I and Type II anterior tongue ties may be less noticeable in infancy because they affect the tongue edge.

Type III anterior tongue tie can cause sharpness disturbance during fast talk and when speaking the words that start with the letters ("R", "S", "T", "D") that require the tongue to touch the upper display.

The video also showed that the patient with a complaint of impaired sharpness and difficulty in some words due to a Type III tongue tie was able to change the tongue tip quite difficultly behind the upper teeth during the mouth opening before the procedure and after the tongue tongue cut under the local anesthesia, it can be seen that when the mouth is open, it can touch the upper teeth and the upper lip.

Type 3 tongue tie may not be understood in many patients and may be perceived as a normal condition by patients. I usually find coincidence in my patients who come to my office, and especially patients who have a problem with speaking or calling out, notice it more in themselves. The distance between the starting point of the tongue tie and the tip of the tongue in babies should be at least "16 mm". This distance is called "free tongue distance" by Dr. Kotlow. If this distance is long, it means that the usable area in the tongue  is long and excessive. In Type 3 tongue tie, this distance is longer than other tongue ties, so the symptoms are less obvious. How short the tongue tie is, how fibrotic or elastic it is, and how much the tongue can be lifted upwards from the floor of the mouth are used in the calculation of the limitation of tongue ties. So even though free tongue distance is enough; When there is a fibrotic and tight tongue tie, the restriction in tongue movements may be excessive. In this video, "lingual frenectomy" operation in the form of removal of tongue tie tissue was performed in office conditions.

Among the methods used for tongue tie surgery are laser, scissors, coblation, thermal welding, electrocautery, radiofrequency. In some types of laser, such as cautery and electrocautery, which can cause heat damage, nerve damage may occur in the adjacent region. The nerves damaged here are usually the sensory nerves and not the motor nerves that move the muscle. It can cause more numbness than normal at the incision site and a long recovery time.

Tongue tie operation age limit

Although there is no general age limit for tongue-tie operations; Especially in patients who will be operated under anesthesia conditions, the procedure may not be performed when there are general health problems related to the administration of anesthesia. Even in newborn babies, tongue tie can be cut using scissors as a simple procedure in office conditions. It is ideal to perform the procedure as early as possible, especially in patients with structural changes in the tongue and infants with breastfeeding problems.

Does the shape of the tongue return to normal after tongue tie operation?

Tongue tie usually emerges from one month in the womb, that is, structural changes in the tongue can occur due to tongue tie even before the baby is born. It is accepted that tongue tie arises from a group of genetic disorders that can affect the tongue and other structures in the mouth. In babies born with tongue-tie and structural changes in the tongue due to tongue-tie, performing this operation as soon as possible may reduce the prognosis of structural changes in the tongue prospectively. For example, if the procedure is done late in babies with tongue-tie reaching to the tip of the tongue, that is, babies with type 1 anterior tongue-tie, different structural changes such as bifurcation, heart-shaped tongue, cleft tongue and v-shaped tongue may occur in the baby's tongue. At the same time, changes in the patient's jaw structure may occur, for example, a problem that may affect the development of serious facial bones, such as narrowing and deepening of the upper jaw, backward lowering of the lower jaw, and an increase in the distance between the upper and lower teeth. It is appropriate to treat patients with structural changes in the tongue and mouth and tongue-tie with tongue and operation before their development is completed. Unfortunately, in patients with these changes, the normalization of the mouth and tongue structure cannot be guaranteed with tongue tie operation.

Our adult patients with structural changes in their tongue often ask us whether tongue aesthetics can be performed due to the following problems:

- the tongue is cleft and looks like a snake's tongue when protruding from the mouth
- the edges of the tongue are prominent and the tip of the tongue is short
- a v-shaped image on the tip of the tongue
- the tip of the tongue is round and blunt, as if cut off

It is not possible for these structural changes to disappear completely after tongue-tie surgery in adult patients presenting with the above structural changes. If the tongue is cut from the sides or in the middle for aesthetic purposes, there is a risk of cutting the motor and sensory nerves in it. Cutting the tongue tie and shaping the tongue tissue by cutting are not the same surgery. I would like to say to our patients who want the tongue to be cut in the vertical axis, especially because it is not permanent but risky in terms of paralysis. A tongue-tie operation in infants can prevent structural changes both in the tongue and in the mouth, prospectively. Apart from the swallowing and oral cleaning functions of our tongue, it also has very important tasks such as shaping the bones in the mouth and on our face. It is a formative and muscular organ. Limitation of the functioning of this organ and permanent change in its structure due to tongue-tie may cause many problems related to nutrition, speech, and development of fascial bones.

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

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