What are the other Names for the Procedure?
- Frenectomy of Tongue
What is the Lingual Frenectomy surgical procedure?
- Lingual Frenectomy is an invasive procedure that is typically performed to remove the small bit of tissue, called the frenum or frenulum, from below the tongue, typically for ankyloglossia
- Ankyloglossia or tongue-tie is a congenital condition wherein the frenulum at the base of the mouth below the tongue is abnormally small/short, thereby restricting the movement of the tongue. This can result in feeding difficulties in infants, speaking difficulties, and change in profile of the jaw (jaw protrusion), over a long duration
- In general, Lingual Frenectomy is a fairly common procedure performed in individuals of all ages (particularly in children)
When a complete removal of the frenulum is undertaken, it is known as frenectomy. However, when only a partial removal is necessary; or in some cases, when a reattachment or relocation of the membranous tissue (frenulum) is necessitated, the procedure is known as frenotomy or frenoplasty.
What part of the Body does the Procedure involve?
Lingual Frenectomy usually involves the tongue and soft tissues at the underside of the tongue.
Why is the Lingual Frenectomy surgical procedure Performed?
A Lingual Frenectomy is performed for the following reasons:
- To treat ankyloglossia or tongue tie
- Chewing and eating difficulties; the condition can also make it difficult to swallow
- Speaking difficulties; difficulty in pronouncing certain syllables or words
- Difficulty in breastfeeding (for both the baby and the mother), which can increase the child’s susceptibility to infections
- To prevent jaw protrusion and other dental health conditions (such as bad breath or gingivitis)
- To improve one’s cosmetic appearance
What are some Alternative Choices for the Procedure?
A Lingual Frenectomy is undertaken based on the assessment of the healthcare provider.
- In some cases, the healthcare provider may choose to follow a ‘wait and watch’ approach, especially in young children
- If necessary, he/she may advocate speech-language pathology therapy instead of a surgery right-away
What are the Recent Advances in the Procedure?
Laser therapy to treat the condition is an advancement to the procedure.
What is the Cost of performing the Lingual Frenectomy surgical procedure?
The cost of Lingual Frenectomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding a Lingual Frenectomy procedure and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
http://admin.ejpd.eu/download/2012_02_03.pdf (accessed on 04/30/2018)
http://www.jaypeejournals.com/ejournals/ShowText.aspx?ID=9970&Type=FREE&TYP=TOP&IN=_eJournals/images/JPLOGO.gif&IID=762&isPDF=YES (accessed on 04/30/2018)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4072276/ (accessed on 04/30/2018)
http://frenectomy.net/ (accessed on 04/30/2018)
Prior to Lingual Frenectomy surgical procedure:
How is the Lingual Frenectomy surgical procedure Performed?
The Lingual Frenectomy may be performed in the following manner:
- Traditional method: Under local anesthesia and using a surgical knife or scalpel, the abnormal frenulum tissue is removed through a simple excision. Following this, dissolvable or removable sutures are used at the incision site
- Modern method: A bloodless surgery may be performed using a CO2 or YAG laser. A laser beam is precisely focused onto the target site and the excess tissue is vaporized (cut and coagulated). This is known as a soft-tissue laser surgery
- Electrocautery (thermal cautery): It is described as a form of electro-surgery where a heated electrode is used to burn the frenum tissue. The procedure does not involve any blood loss
Where is the Procedure Performed?
A Lingual Frenectomy is usually performed in an out-patient surgery center facility, a dentist’s or periodontist clinic/office, or a hospital.
Who Performs the Procedure?
A dental surgeon or general surgeon performs a Lingual Frenectomy.
How long will the Procedure take?
The time taken depends on the type of Lingual Frenectomy technique used; however, the entire procedure may not take more than 30-60 minutes. The actual surgical (incision) procedure may take only a few minutes.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Lingual Frenectomy and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Lingual Frenectomy using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Lingual Frenectomy surgical procedure?
Before a Lingual Frenectomy, the patient may undergo certain tests such as:
- Oral cavity examination
- Routine blood and urine analysis, if needed
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Lingual Frenectomy?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
- What are the costs involved?
During the Lingual Frenectomy surgical procedure:
What kind of Anesthesia is given, during the Procedure?
Local anesthesia by injection is administered prior to the Lingual Frenectomy procedure. However, this may not be necessary, if electrocautery or lasers are used.
How much Blood will you lose, during the Procedure?
- The blood loss during a Lingual Frenectomy is usually minimal when the scalpel technique is used
- No blood loss occurs in a laser surgery or thermal cautery technique
What are the possible Risks and Complications during the Lingual Frenectomy surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Lingual Frenectomy are:
- Excessive bleeding
- Infection of the surgical wound
- Anesthetic complications
- The soft tissues around the frenulum is burnt or damaged
- Damage to the nerve may take place
What Post-Operative Care is needed at the Healthcare Facility after the Lingual Frenectomy surgical procedure?
At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise
After the Lingual Frenectomy surgical procedure:
What are the possible Risks and Complications after the Lingual Frenectomy surgical procedure?
In a vast majority of individuals, no significant complications are noted. However, in some, the possible risks and complications that may arise after the Lingual Frenectomy procedure include:
- Excessive bleeding
- Pain and bruising at the surgical site
- Swelling of the lips and gums
- Infection in the surgical wound
- The tongue movement may still be restricted, necessitating further procedures
What is the Prognosis after the Surgery?
- A complete recovery from Lingual Frenectomy procedure is generally achieved
- The prognosis is excellent without any serious complications being observed in a majority, since it is typically a safe and uncomplicated procedure
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Worsening pain and swelling of the surgical wound
- Bleeding or fluid drainage from surgical wound
- Swollen gums or lips
- The occurrence of any symptom that causes uneasiness such as nausea or vomiting
- Signs of an infection
- Fever, feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Lingual Frenectomy surgical procedure?
At home, the following post-operative care is recommended after a Lingual Frenectomy:
- Pain-relief medication may be prescribed
- Keep the area clean using a gauze, per the healthcare provider’s instructions
- Saltwater gargles or rinses are advised for a few days (2-3 times per day)
- Complete the course of prescribed medication/antibiotics as advised by the physician
- Individuals are advised to have to clear liquids following the surgery and after bleeding is stopped (for the next 24 hours). Following this, they may take soft foods, till recovery (for about 3-5 days)
- Have a well-balanced diet, which can aid in a faster recovery; avoid hot, spicy, or hard foods for a certain period of time
- Keep mouth clean/clean teeth using suitable toothbrush and toothpaste
- Follow-up visits (to remove sutures, if any) are advised, as recommended by the healthcare expert
How long does it normally take to fully recover, from the Procedure?
A complete healing and recovery takes place in a few days to a week. However, the time of recovery is generally lesser when the laser method or electrosurgery is used for Lingual Frenectomy.
What happens to tissue (if any), taken out during the Procedure?
Generally, the procedure does not involve the surgical removal of any tissue.
- However, occasionally, the healthcare provider may decide to send the tissue for a pathological analysis
- In such cases, the tissue is taken for further examination and later disposed as per the standard medical procedure
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
Usually, no tissue is sent for a pathological analysis. However, if the tissue is sent for laboratory analysis, then:
- The tissue removed is processed in the laboratory under a pathologist's supervision
- Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Lingual Frenectomy surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient facility, dentist’s or periodontist clinic/office, or a hospital
- An anesthesiologist (if anesthesia was administered)
- A dental professional or general (oral) surgeon
- A pathologist (if the tissue is sent for analysis)
The patient is advised to inquire and confirm the type of billing, before the Lingual Frenectomy is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA