Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › Tongue tie
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Glenn van AsSpectatorExcellent photos, really great case RON…..doesnt it make you feel good.
Well done.
Make sure you get him back in a week and I am thinking that they have to keep practicing to stick the tongue out.
The only relapse cases I have had are these lingual tongue ties. Some feel that the suture shouldnt go in at the attachment but be placed in the floor of the mouth where the end of the cut is.
Watch how much it reattaches……….
Its amazing.
All the best and what an awesome result. Kudos to you.
Glenn
Interesting about the speech impediments. Its also interesting when you ask them to lick their top lip. Most cant do it.
Glenn
whitertthSpectatorThis is a perfect case to apply the glustitch as a irritant to retard healing a drop to prevent reattachemnt..I just saw the post op of a recent frenectomy I did with the glustitch and the outcome is increddible…I will post photos next week when she returns for final post op…Nice case Ron!!
StomotologSpectatorsince the tounge is constantly mobile, how would reattachment occur?
DrOSpectatorRon–
I’m not familiar with Glustitch. What is it? …Where do you get it?
JanetCenturySpectatorAndrew said: Yet a simple procedure like a release of a tongue tie will provide an immense change to a patient who swallows hundreds of times each day for the rest of his/her life. That patient will be less likely to choke in swallowing, will be able to take a vitamin tablet easier, will be able to speak more clearly and freely…. As I tell my patients about lingual frenectomy: You don’t know about the freedom until you have it. And once you have it, you won’t want to lose it.
The first kid I did had a comment that made us (me and Mom) want to bawl at his one week check up – he said “Now I’m like all the other kids”. You just never know how what you do can affect someone.
Janet
N8RVSpectatorI’ve only done a couple of lingual frenectomies — both on the same patient! The first time, I neglected to suture. Had good release, good extension of his tongue. A few months later, it had relapsed almost entirely and had to redo with a suture. So far, so good.
Saw on today’s schedule “frenectomy” and, for some reason, was thinking maxillary.
“How old is Dylan?” I asked.
“Uh … six, I think,” was the response.
Well, I came into the room and saw this barely-four-year-old, all smiles. Good sign. Looked under his upper lip — all normal. Oops. “Dang, I really wasn’t prepared for this,” I’m thinking.
Used some Tricaine Blue, infiltrated a few drops of Articaine and let him sit. So far, so good.
Clamped the frenum with a hemostat, used the chisel tip in non-contact at 50Hz/40mJ and it just zipped right through — with absolutely no bleeding or charring. Pretty slick.
Took off the clamp, asked Dylan to stick out his tongue, which he did and was amazed at how far he could stick it out! All smiles. Man, I was feeling pretty good about that …
Before I could even finish explaining to Mom what I had done, barely able to contain my pride, I heard a disconcerting noise from the waiting room. Sobs.
Seems Dylan, who was so happy just SECONDS before, is suddenly in pain. Huh? As we coax him back into the chair to take a look, I whip out the topical again. Plop some topical on it, say, “Does that feel better now, buddy?” and he nods.
Goofy, huh? BTW, still no bleeding.
With the way the tissue looked, I’m not expecting to see any relapse. I may be wrong, and told Mom as much.
Other than the mercurial temperament of 4-year-olds, any ideas why he went from joy to tears in mere seconds?
(sorry I don’t have any pix — would’ve been a good one, too. However, I just wanted to get it over and done ASAP!)
— Don
cadavisSpectatorThanks for the pics. I recently purchased an Opus Duo and have been dieing to see some actual pics of procedures.
Thanks guys.
drkddsSpectatorMan, it’s been a long time since I’ve been here to the LDF. And I have no idea why…
Well, my ortho referral is returning the favor and referring me a tongue-tie release. I have not done one yet and I’m going to consult with the parent and child on Thursday. I figured I should bone up a little bit before I see them. I don’t even have a fee in place yet and what ADA code is this? Any suggestions for a fee…N8RV (Don) and Ron you are reasonably close geographically…any siggestions from you?
I will be taking pictures, so I’ll post some on Thursday evening.
I have been using the TAC gel (alone) with mixed results and am thinking I will probably add some local after the TAC gel.
How does placing a suture at the superior aspect of the incision prevent re-attachment? I’m planning on using 4.0 gut since it’s all I have.
I’m eager to do this treatment finally – almost 2 years into DELight ownership.
AnonymousGuestDoug, I think if you’re placing a suture, you definitely want some local. I haven’t placed suture on mine but have them do the ‘exercises’ that were earlier mentioned.
Look forward to seeing the pictures.
You have a P.M.
drkddsSpectatorWell, I did the consult today for a tongue-tie release. Mom was eager to get the treatment completed and since I had a cancellation I went ahead and completed the treatment. Everything went well: the child cooperated, there was ZERO bleeding, and there was noticable increase in mobility.
Here’s my procedure: TAC gel on floor of mouth and ventral surface of tonuge, coered by 2×2 for 3 minutes. 0.6cc Septocaine infiltration into frenum and adjacent tissue. I clamped the frenum with hemostat and disected the attachment using the DELight (Er:YAG) @ 45/55 +Air -Water. I placed (1) CG 5.0 suture at the superior aspect of the incision.
[img]https://www.laserdentistryforum.com/attachments/upload/IMG_1241.JPG[/img]
[img]https://www.laserdentistryforum.com/attachments/upload/IMG_1242.JPG[/img]
[img]https://www.laserdentistryforum.com/attachments/upload/IMG_1246.JPG[/img]
[img]https://www.laserdentistryforum.com/attachments/upload/IMG_1247.JPG[/img]
I welcome your critiques…this is my first tongue-tie release. Did I over-disect the attachment?
(Edited by drkdds at 11:31 am on Feb. 16, 2006)
drkddsSpectatorBTW, I used the chisel tip.
Glenn van AsSpectatorLooks great and wonderful job. What were you settings again. Was it in contact with the chisel tip. In addition please make sure that the patient continues to tear the attachment by sticking their tongue out. These lingual tongue ties are notorious for reattaching.
Make sure that they continue to daily lick their lips and get as much movement thereby constantly tearing the attachment to prevent reattachment at another level.
Cya
glenn
drkddsSpectatorThanks, Glenn.
I used the chisel tip in non-contact mode 45 Hz/55 mJ with air/without water. I was about 1-4 mm from the tissue throughout the treatment.
I started getting a little concerned about the size of the dissection when I reviewed this thread after completing the procedure. The other dissections look so small. Does anyone think it looks too aggressive?
BTW, this is an 11 year old girl who was referred to me by my main ortho referral with complaints (by mom) of speech impairment, inability to keep her lips moist and trouble swallowing pills. My orthodontist attended a lecture I gave to our local Young Dentist group last November. I am going to devote some more effort to getting the word out about this treatment to my other orthodontists and pedodontists. The laser really shines on these! (no pun intended!)
I spoke to mom about 30 minutes ago and the patient is a little uncomfortable but doing well. She has eaten lunch and dinner and has just taken her first dose of OTC pain meds. Treatment was performed at 10:30am today and mom said there has been ZERO bleeding all day. NOT ONE DROP!!! Amazing….
drkddsSpectator
I saw the patient on Monday for a follow-up visit. Mom and patient reported mild discomfort the day of, and the day after, treatment. Since then there has been no discomfort. The suture is no longer in place, but the healing appears to be progessing normally. There’s a significant change in mobility after the release. Mom and patient are very impressed with the ease of the procedure and minimal discomfort.
Thanks to everyone here on the forum for their posts and case presentations!!!
(Edited by drkdds at 9:13 pm on Feb. 21, 2006)
Lee AllenSpectatorI thought that I would revisit this topic since I am planning a lingual frenectomy on a 4 year old. Mom is concerned about the speech development and had an evaluation to confirm her fears.
Now to the task: Do you think that topical (DRK Liquid) is adequate for this alone, but if injecting what is the site, objective anesthesia zone, and just a drop or a portion of carpule?
My plan is to use topical since the degree of tie is much less than pictured so far. Cooperation will fly out the window if he is hurt however.
Using the Waterlase (classic) at .5 W (20Hz / 25mJ for the YAG users) and 15% Water and Air.
I anticipate little bleeding, and no pain since this is less energy than prior reported useages here and for thin tissue it is effective. The tip I like to use is a tapered tip that is 400 microns diameter at the working end. That may mean with a chisel tip the power densities may be the same. Hummmm.
The advice I am looking for is:
1. is this a good plan with regard to anesthesia2. would you place a suture in a 4 year old? Or, how effective is the tongue pointing exercise?
Thanks for your assistance.
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