case report

Management of Ankyloglossia with Scalpel and

Electrosurgery Method
V Ramya*, N Mani Sundar*, Anitha Balaji**

Abstract
The tongue is the important oral structure that is responsible for speech, swallowing and positioning of the teeth. Ankyloglossia
or tongue tie is the result of short tight frenulum that causes limitation in tongue movement, therefore when the tongue is
retruded it causes blanching of the soft tissue and also place excessive force on the mandibular anteriors. The lingual frenum
may cause midline diastema in lower central incisors. This case report describes two cases where the patient diagnosed with
ankyloglossia underwent lingual frenectomy procedure by two different techniques electrosurgery and scalpel method under
local anesthesia without any complications. After a follow up of 6 months the healing was uneventful without scar formation
in both the cases. The tongue showed good healing with protrusion several millimeters beyond the lower lip.

Key words: ankyloglossia, lingual frenum, electro surgery,

E
tymologically ankyloglossia comes from a
Greek word agkylos-“crooked”, glossa-“tongue”.
The term free-tongue is defined as the length
of tongue from the insertion of the lingual frenum
into the base of the tongue to the tip of the tongue.2
Partial ankyloglossia (also called tongue-tie ) is caused
by a frenum of the tongue that is abnormally short
or is attached too close to the tip of the tongue.
This condition may be surgically corrected by simple
excision. Complete ankyloglossia requires extensive
surgical reconstruction of the tongue and the floor of
the mouth.
CASE REPORT
CASE 1
A 22 year old patient reported to OP, Department
of Periodontics and implantology of Rajah Muthiah
Dental College And Hospital, Annamalai University,
With complaint of difficulty in complete protrusion
of the tongue. His ENT and physical examination
was normal. On intraoral examination the individual
was diagnosed with class II ankyloglossia by utilizing
kotlow assessment.2 [fig I]. There was no recession
in relation to mandibular incisors lingualy. When
the patient was asked to retrude the tongue, slight
blanching was seen lingual to the anterior teeth with
midline diastema in lower anteriors. The patient was
informed about the treatment procedure and lingual
frenectomy was undertaken under local anaesthesia
with 2% lignocaine and l: 80000 adrenaline, No 15
blade was used to make incisions on the either side
of the frenum [fig II]. A diamond shaped wound was
made and the frenum was removed [fig III]. The blunt
end of the instrument was used to relieve the pull by
muscle fibres so that tension free closure of the wound
edges can be obtained. The wound was approximated
with (4-0) black braided silk sutures [fig IV]. The
patient was given medication for 3 days to reduce post
operative pain and infection. After a week sutures were
removed and after a follow up of 6 months the healing
was uneventful without scar formation [fig v]. The
tongue showed good healing with protrusion several
millimeters beyond lower lip.
CASE 2

*Senior Lecturer A 24-years-old male reported to OP with difficulty in

** Reader speech and was diagnosed with class II ankyloglossia.
Dept. of Periodontics
Sree Balaji Dental College and Hospital, Chennai. (Able to protrude upto lower lip) (fig VI and VII). The
Address for correspondence patient was under taken for frenectomy procedure by
V Ramya
Senior Lecturer electrosurgery under local anaesthesia. It is a surgical
Dept. of Periodontics technique performed on soft tissues using controlled,
Sree Balaji Dental College and Hospital, Chennai.
E-mail: dr.ramya@yahoo.co.in high frequency electrical (radio) current in range of 1.5

472 Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 2, February-April 2012

 Case Report

Fig. I Class II ankyloglossia Fig. II Excision with scalpel method

Fig. III Excision of frenum Fig. IV Sutures placed

Fig. V Six months post operative Fig. VI class II ankyloglossia

Fig. VII Fig. VIII electrosection done

Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 2, February-April 2012 473

 Case Report
Fig. IX Frenum excision
to 7.5 million cycles per second or megahertz. There are
three classes of active electrodes, single wire electrode
for incisions and excisions, loop electrode for planning
procedure and heavy bulkier electrode for coagulation
procedure of which single wire electrode was used for
frenectomy procedure. Electrosection also referred as
electrotomy was the basic technique performed for
excision (fig VIII). The tip was kept moving with
interrupted application at adequate interval for tissue
cooling (5-10 sec) to reduce or to eliminate heat build
up. Approximation of the wound was not required and
bleeding was less (fig IX). Medications were prescribed
to reduce post operative pain and infection. After 6
months of post operative review, healing was uneventful
by primary intention (fig X).
DISCUSSION
Ankyloglossia is a rare congenital oral anomaly
that causes difficulty in breast feeding and speech
articulation. The prevalence of ankyloglossia is also
higher in studies investigating neonates (1.72% to
10.7%) than in studies investigating children and adults
(0.1% to 2.08%).5 In many individuals ankyloglossia
is asymptomatic and may resolve spontaneously.3 The
ankyloglossia can be classified into four classes based
on KOTLOW’S assessment;1
Clinically acceptable - normal range of free tongue
greater than 16mm,
Class I Mild ankyloglossia: 12 to 16 mm
Class II Moderate ankyloglossia: 8 to 11 mm
Class III Severe ankyloglossia: 3 to 7 mm
Class IV Complete ankyloglossia: less than 3 mm
474 Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 2, February-April 2012
Fig. X 6 months post operative
Therefore the surgery for ankyloglossia should be
considered at any age depending on patient’s history
of speech, mechanical and social difficulty. In both
the cases there was no significant difference in healing
after soft tissue resection by both the methods. This is
similar to the study done by Fisher SE and Flocken
JE.4 However the electrosurgery permitted adequate
contouring of the tissue and adequate control of
hemorrhage in accordance to study done by Oringer
M et al3 The major disadvantage of this electrosurgery
was that it caused unpleasant odour and furthermore
extreme care had to be excised to avoid contacting
tooth surface, as the heat generated by injudicious use
can cause tissue damage.
CONCLUSION
To conclude, if severe/complete ankyloglossia is present
in adult there is usually an obvious limitation of the
tongue protusion, elevation and speech problems,
which can be improved by surgical intervention.
REFERENCES
1. Lawrence A. Kotlow Ankyloglossia (tongue-tie): A
diagnostic and treatment quandary. Quintessence
International 1999; 30:259-262
2. Tanaj, chaubal, maladixit Ankyloglossia and its
management. J Indian Soc Periodontal 2011: vol 15;
270-272
3. Oringer MJ Electrosurgery for definitive conservative
modern periodontal surgery .Dent clin North Am vol
13; 53: 1969
4. Fisher SE, Frame JW Electrosurgical management of soft
tissues and restorative dentistry. Dent clin North Am vol
24:247; 1980
5. Suter VG, Bornstein MM Ankyloglossia: facts and myths
in diagnosis and treatment J Periodontol. 2009 Aug;
80(8):1204-19