Tongue tie

[2thlaser]

Lee,
Good to hear from you. First, I would avoid a tapered sapphire tip. Too much energy. I really think also that DRK liquid would work great. I would recommend 1-1.5W using a Z-6 6 or 9mm tip, defocussed, and if you really wanted to use a sapphire, the C-3 chisel is the only other choice. You really won’t get much if any bleeding if you use the Z-6 defocussed. Energy level will depend on how fast you want it to go in YOUR hands. All of us are a bit different. If you need any more advice, PLEASE call me anytime. I miss hearing from you…Lori says hello!

All my best,
Mark

[Lee Allen]

Mark,

Great information. I assume that you are recommending 15% air and water. Water being the important factor. Without it the “heat” is noticed.

I have been focused on water setting lately, and wonder on another subject, why we expect the water to travel the distance below tissue level to the tip when doing endo or in “zapping” a fistula. The water amount has to be too low at best and probably non existent the majority of the time at 20 Hz. A case where we are using the Erbium for effect like a NdYag. [Big picture, Bob, I know there are different absorbtions.]

Having only tried the DRK liq on myself under the tongue, it does not seem possible that one can grab the frenum and fire up the Erb. What is your take on its effectiveness?

Thanks for getting back to me on the tips and settings right away.

[2thlaser]

Hi Lee,
I like your air/water settings. SHould work good. Believe it or not, the capillary action of the water moving into a root canal space with the Z-2 fiber is amazing. That is why we came up with the 34/24 air/water ratio’s a few years back. Dr. Chen showed this utilizing a perioscope I believe.

On DrK Formula, it works real well, almost too well, but I do leave it on for about 4-5 minutes before I start. Sometimes I use a bit of EMLA cream with it to keep it on the tissues. Let me know how it goes!

All the best,
Mark

[Lee Allen]

Mark,

Your recommendations were right on.  I saw little Mack, the 4 year old with the lingual tongue tie, and it worked better than expected.

I used my Erbium YSGG (classic) with your recommended Z-6 tip at 1.0 W with 20%water and 15% air.  The DRK liquid was applied with a cotton swab for 3 minutes on both sides of the frenum from the tongue to the attached gingiva.  On observation the attachment at the gingiva was at the mucogingival junction already so I did not ablate it, but the tongue had a tight frenum all the way to the tip with an obvious fibrous band at the crest of the frenum which blanched when stretched.

I clamped the frenum.  That was the first amazing thing.  No pain or reaction from Mack.  I just dissected the frenum from the underside of the tongue and around the hemostat avoiding the salivary gland duct. Man did it gape open when completed.  And suddenly it was done and without any, and I mean any, bleeding.   When we showed the Mom she was the happiest of all of us.  Almost to tears.

It took 10 minutes total.  Pre-op I tested his tongue reach and he could not touch my finger placed just under his vermillion border of his lower lip about at the gingival crest level.  Post op we have a reach to the mid chin button.

As recommended earlier in this post, I am relying on a motivated mother to keep him on task several times daily putting his tongue out to touch a finger placed at this spot.  I did not think that suturing would be possible given that we had tested his patience to this point.  I have had great sucess using a suture for maxillary fenectomies, but at least there is an alternative with the lower one.  New territory for me, so after 37 years of practice, I am still learning.

A very big THANK YOU to all who have given advice on this subject on this forum.  It is the only conduit for this information I have found.  Without it, the treatment and impact on the patient would have been very different.  

For that reason, we all share in the successful treatment.  :biggrin:

I wish I could convey the happiness of the mother in seeing that her son did not have to endure the recommended treatment of the Speach Pathologist and Oral Surgeon.  Truely miraculous in her eyes and grateful beyond words.

(Edited by Lee Allen at 1:30 am on April 1, 2006)

[Glenn van As]

Hey Lee……AWESOME. Your ethusiasm and happiness probably match the moms. Your clinical descriptions are vivid and great. I dont do these without first anesthetizing so it was great to hear that you did…..

CLAP CLAP CLAP

Thanks for sharing and each and every day I thank Ron Schalter for this great site where learning on lasers is so wonderful.

Cya

Glenn

[Lee Allen]

Thanks Glenn,

I am thankful for your comments.

While I am not the most adventurous with my Erbium, when success of this magnitude comes along, I wish I were 20 years younger and I would commit more resources and time to laser dentistry.

Since you asked, ideally, I would have at least 2 more: the FRP NdYAG and a diode to compliment the Erbium. Perhaps investigate a CO2. And of course light and magnification: the microscope. Ahhh.. enlightenment that comes late.

Thanks again, everyone.

[2thlaser]

Once again Lee, you have proven who you are. I have been very privleged to meet you, and spend time with you. I have NEVER doubted your abilites with the laser. I am so happy things worked out for your case. ANY time you need ANYTHING, you can call, or email. Glenn is right, this is a wonderful forum for us. Great things to share and get answers for.

From Florida, in Gainsvile, the home of the Champion Gators!

Mark

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