Recommended Treatment and Aftercare for Tongue Frenectomy
The recommended treatment for ankyloglossia (tongue-tie) is surgical frenectomy with post-operative speech therapy for immediate rehabilitation, followed by careful monitoring for complications and implementing appropriate pain management. 1
Diagnosis and Indications
- Diagnosis of tongue-tie is based on clinical examination, evaluating tongue mobility, appearance, insertion, attachment, and shortness of the lingual frenulum 1
- Indications for frenectomy include articulation difficulties confirmed by a speech pathologist, mechanical limitations such as inability to lick the lips, perform internal oral toilet, or play wind instruments 2
- In some cases, problems with feeding and suction in infancy may warrant intervention, though evidence for this is primarily anecdotal 2
Surgical Approach
- Frenectomy should be performed with minimal trauma due to the high vascularization and mobility of the tongue to avoid post-operative complications 1
- Options for surgical correction include:
- Conventional surgical frenectomy under general anesthesia (recommended for children) or local anesthesia (appropriate only for cooperative teenagers) 2
- Laser-assisted frenectomy using diode laser, which offers advantages of simplicity, safety, minimal bleeding, reduced chance of infection, and decreased swelling 3, 4
- There is no place for division of tongue-tie without anesthesia in newborns 2
Post-Operative Management
Pain Management
- Implement multimodal analgesia with scheduled administration of medications 5
- Administer ibuprofen and acetaminophen as baseline therapy for pain control 5
- A single intraoperative dose of intravenous dexamethasone should be administered for its analgesic and anti-emetic effects 6, 5
Monitoring and Complications
- Monitor for signs of primary bleeding (within 24 hours of surgery) and secondary bleeding (occurring later than 24 hours after surgery) 5
- Most interventions required during the postoperative period include administration of oxygen or repositioning if respiratory issues occur 5
- Perioperative antibiotics should not be administered, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 6
Rehabilitation
- Speech therapy should be initiated immediately after surgical correction for optimal outcomes 1, 7
- Orofacial myofunctional therapy is recommended to prevent relapse and ensure long-term excellent results 3
- Regular follow-up visits should be scheduled to monitor improvement in tongue movement and to check for relapse 1, 3
Outcomes and Timing
- Frenectomy is associated with significant improvement in speech articulation (0.78; 95% CI: 0.64-0.87; P < .01) 7
- Earlier intervention is associated with better outcomes, as increasing patient age is negatively correlated with post-frenectomy speech outcomes 7
- A marked improvement in tongue movement can be observed at follow-up visits after proper surgical treatment 1
Common Pitfalls and Considerations
- Speech difficulties related to tongue-tie are often over-rated while mechanical problems are frequently underestimated 2
- Conventional surgical correction can cause bleeding, infection, swelling, and relapse if not performed properly 3
- Failure to provide appropriate rehabilitation through speech therapy and orofacial myofunctional exercises may lead to suboptimal outcomes 3, 7
- Regular post-operative follow-up at 3-month intervals is important to check for and address any relapse 3