Revision Lingual Frenectomy / Frenotomy

Revision Tongue Tie Release Surgery in Istanbul, Turkey

In the video above, the pre-operative and post-operative images of the patient, who had undergone a simple tongue tie release procedure in another clinic and who underwent a revision tongue mesh operation (frenectomy). In the examination of the patient who had clarity in some letters while speaking, the tongue tie structure was seen and according to the Ferrés-Amat Functional Tongue Tie Classification System, Tongue range of motion ratio - Tongue range movement ratio - TRMR was determined as 50-80%. It was stated by the patient that the patient, who is a manager in a company and who actively talks on the phone, has more clarity, especially when speaking quickly. After the procedure, it is seen that the tip of the tongue can touch the upper teeth comfortably with the mouth wide open (TRMR greater than 80).

About Tongue Tie and Surgical Treatment

What Is Ankiloglossia? Why Does It Occur?

Tongue is an important organ that affects speech, position of teeth, periodontal tissue, nutrition and swallowing. Most of us think of ourselves as a situation we find when we're so excited about speaking the tongue tie. Tongue tie is actually the non-medical term for a relatively common physical condition that limits the use of tongue called ankyloglosia.

Before birth, a strong cord of tissue guides the development of the oral frenulum located in the middle of the mouth. After birth, this lingual frenulum continues to guide the position of the emerging teeth. As the child grows, it straightens and becomes thinner. This frenulum can be seen when looking at the mirror under the tongue. In some children, the frenulum is particularly tight or cannot be retracted and may cause tongue immobility. Thus, ankyloglosia is defined as a developmental anomaly of the tongue characterized by an abnormally short, thick lingual frenum that causes limitation of tongue movement, or simply, if the lingual frenulum continues close to the tip of the tongue, the tongue tie is created resulting in reduced tongue movement.

Various studies using different diagnostic criteria have found the prevalence of ankyloglossia between 4 and 10%, and the incidence of tongue tie ranges from 0.2% to 5%, depending on the population studied. While the ratio of women to men is 2.5: 1.0, it is more common in men. In infants, ankyloglosia has an incidence rate of 25% to 60%, and its presence can cause difficulties ranging from failure to breastfeed to even refuse to breast.

Ankyloglossia may also be part of some rare syndromes such as Smith-Lemli-Opitz syndrome, orofacial digital syndrome, Beckwith Weidman syndrome, Simpson-Golabi-Behmel syndrome, and X-linked cleft palate with autosomal dominant or recessive features.

Ankyloglossia in children can cause difficulties in diagnosis for dentists. Recent reviews have revealed little information about what constitutes an abnormal lingual link and what criteria should be used to justify surgical intervention.

Ankiloglossia Anatomical and Functional Descriptions

The anatomical definition of ankiloglossia consists of absolute measurements as well as explanations. Descriptions include the attachment of the frenulum to the tongue, the attachment of the frenulum to the lower alveolar ridges, the flexibility of the lingual frenulum, and the appearance of the tongue when lifted. Absolute measurements include the length of the lingual frenulum and free tongue length when the tongue is lifted. You can find the anatomic tongue tie classification criteria and the Ferrés-Amat Functional Tongue Tie Classification System made accordingly on this website.

The Symptoms of Tongue Tie Can Be Appeared in a Very Wide Range!

In people with tongue tie, the appearance of the tongue may be abnormal. Improper chewing and swallowing of food can increase stomach upset and bloating, and sleep snoring and bedwetting are common among tongue-tied children. It also affects children who want to participate in routine play involving tongue movements, different sounds, and speech. Tooth decay can occur due to the inability to remove food debris due to the tongue's action of sweeping the teeth and spreading saliva. Tongue - related pushing, periodontitis, spreading of the lower incisors and open biting due to tooth mobility due to prolonged tongue pushing are related problems. It also affects self-esteem because it has been clinically stated that at times an older child or adult will be self-conscious or embarrassed about their tongue ties that they may mock up for their abnormalities by their classmates. Baby feeding problem can be experienced due to latching of the nipple to the nipple, which can squeeze the nipple into the gum causing breast pain in mothers, and therefore mothers often try to slide the baby to the bottle.

Tongue Tie Surgery Decision

There is a wide difference of opinion regarding the clinical significance and optimal management of the tongue tie. In many children, ankyloglosis is asymptomatic and the condition may resolve spontaneously or affected children can learn to compensate for reduced lingual mobility. However, some children benefit from surgical intervention of the tongue tie. Parents should be educated about the possible long-term effects of tongue tie so they can make an informed choice about possible therapy.

Appropriate clinical guidelines are essential for effective management. The most important factor to consider in ankyloglosis is the normal range of motion of the tongue, which should be determined using the criteria in which Kotlow's classification ranges from class I to class IV. The tip of the tongue should protrude out of the mouth, without bifurcation, and should sweep easily without straining the upper and lower lips. When the tongue is pressed again, the lingual tissue should not stress the anterior teeth and exert excessive force on the mandibular anterior teeth. The lingual frenum should not form a diastema with the mandibular central incisor, and the frenum should not prevent a baby from sticking to the mother's nipple while nursing.

The functional movement and appearance of the tongue can be determined using the Hazelbakers assessment tool. In this tool, points are awarded for each movement of the tongue and the appearance of the tongue. If the functional and appearance score is below 11 and 8, surgical discovery should be considered. You can also find information about the "TABBY" Visual tongue Attachment Assessment Tool, which is a functional tongue assessment scale for babies, on the internet.

Tongue Tie May Create Problems in Shaping Words While Speaking (Articulation)!

Patients should be asked to pronounce some words starting with "I", "th", "s", "d" and "t" in order to check the accuracy of their word pronunciation. If a defective speech is observed, after postoperative wound healing, it is necessary to consult a speech therapist for speech modification. After the surgery, the tongue muscle exercises should be explained to the patient, such as licking the upper lip, touching the hard palate with the tip of the tongue, and side-to-side movements for tongue movements.

Revision Tongue Relase Surgery Decision

Revision tongue tie surgery can be performed in patients who have previously undergone surgical procedures for the tongue tie and whose tongue tie symptoms persist or do not decrease sufficiently.

Tongue tie affects a significant number of babies and children. It is interesting that such a simple situation can cause such controversy and diversity of opinion. While lingual frenectomy operation, which consists of cutting only a very small amount of tongue tie, is performed; Sometimes "lingual frenectomy" operation can be performed in which the tongue connective tissue is removed. However, it is important to provide parents with accurate information and guidance on the indications and potential benefits of tongue tie revision, and appropriate provisions for infants and children requiring revision.

In Which Situations Is Revision Tongue Tie Surgery Required?

I have written this information in similar links below, but to summarize briefly, revision tongue tie operation may be required if breastfeeding problems persist, insufficient weight gain, and functional tongue tie accompanying nipple damage is detected again after tongue tie surgery in babies. In adult patients, a revision tongue tie operation may be required if the movement restriction of the tongue continues despite the severing of the tongue tie, the amount of functional limitation is not reduced enough and the tongue tie structure is seen in the accompanying examination. After the tongue tie is cut, the partial adhesion rate is high. Tongue tie exercises or tongue tie massage may be recommended after the procedure.

In the photo above, there are pre-operative and postoperative images of the patient who had a simple tongue tie cutting operation in another clinic and a revision tongue tie operation (frenectomy). In the examination of the patient who had clarity in some letters while speaking, the tongue tie structure was seen and according to the "Ferrés-Amat Functional Tongue Tie Classification System", the "Tongue range of motion ratio - Tongue range movement ratio - TRMR" was determined as 50-80%. It was stated by the patient that the patient, who is a manager in a company and who actively talks on the phone, has more clarity, especially when speaking quickly. After the procedure, it is seen that the tip of the tongue can touch the upper teeth comfortably with the mouth wide open (TRMR> 80).

The photo above is a view before and after the lingual frenectomy operation with thermal welding device, which was made in a baby who had a simple tongue tie incision (frenulotomy) previously made by a pediatrician and who had a restriction in tongue movements due to adhesion in the tongue.

In the video above, the patient, who previously had a simple tongue tie cutting operation in another clinic abroad, who applied due to re-adhesion of the tongue tie and restriction in tongue movements again, had a revision tongue tie operation (frenectomy), and the patient's pre and post-operative images are available. In the examination of the patient who had clarity in some letters while speaking, the tongue tie structure was seen and according to the "Ferrés-Amat Functional Tongue Tie Classification System", the "Tongue range of motion ratio - Tongue range movement ratio - TRMR" was found to be 40%. It is noteworthy that the tip of the tongue is round and blunt and it is wider than the normal appearance of the tongue. Thermal Welding Device wwas used to triangle shaped tissue resection from tongue tie tissue.