Surgery Options For Tongue Tie in Infants

Appropriate treatment for tongue tie (ankyloglossia) is the subject of much debate. The debate is not about the effects of tongue tie but whether surgery is an appropriate treatment. Opinion on the matter varies depending on the professional. Dentists, lactation consultants, speech-language pathologists, surgeons, or general practitioners all have their own separate opinions.

There is, however, an ingrained reluctance to recommend surgery. This leads to many years of a child trying to perform verbally at a level he or she can never achieve. More often than not, tongue ties that are not corrected an infancy need to be corrected later in the child’s life.

Snipping

This method was used by midwives as far back as 1697, to free the tongue of infants who were having difficulties feeding. Recently, it is being advocated by eminent paediatric surgeons and lactation consultants who see a role for trained dentists, midwives, nurses and lactation consultants in using this simple and effective method of releasing a tight frenulum that is inhibiting breastfeeding in infants.

Sucking is reported to improve immediately after the procedure, which causes minimal bleeding or discomfort for the baby, improves the efficiency of latching and prevents the severe pain experienced by mothers during attempts to breastfeed.

No anaesthetic or analgesic is involved in the process. The tight frenulum is released with scissors and pressure is immediately applied to the cut to reduce bleeding.

Pros and Cons of Snipping

If the only goal were to improve breastfeeding, snipping the tie in infancy would be the obvious solution. No anaesthetic is needed, it is relatively cheap, the infant’s pain is slight, bleeding is negligible, and feeding improves immediately.

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Laser Surgery

This relatively new option is suitable for infants, older children and adults. No general anaesthetic is used, but an analgesic gel might be applied. The procedure is very quick, taking only 2 to 3 minutes to perform, but some cooperation from the patient in keeping still is required.

There is virtually no bleeding, no pain, no risk of infection and the healing period can be as short as 2 hours. It is best to have this procedure performed by a specialist in the area of laser dentistry who is familiar with tongue tie revision.

This method does not require a general anaesthetic and can be performed as an outpatient service with a local anaesthetic. Hence, it is a economical and safe option which can be used to revise mild tongue ties, i.e. when blood vessels are not heavily involved, and tethering of the tie is not extensive. Its proponents describe it as a viable office-based procedure in cases of mild Ankyloglossia.

Some tongue ties are much more severe than others and may require more than one procedure to completely release the tongue. This is uncommon, but not unknown and a later operation can deliver a completely successful release.

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