Indications for Lingual Frenectomy?

A lingual frenum is often than not,an indication of narrow arch space; the frenum during growth shapes the palate, and in turn the skeletal development of the face, palate, max and mand arches. If you release the frenum without a proper assessment by a myofunctional therapist, sleep studies, orthodontist, ENT, you could create more harm than good. Retrusion of the tongue following the frenectomy could result in obstruction of the airway. Not so simple.

This is an absolutely standard tongue tie which is a not uncommon finding in adults. Almost never leads to a speech defect and usually the only minor complaint is that the the individual can't clear food from their lower buccal sulcus with the tip of their tongue. Younger children may be embarrassed that they can't poke their tongue out! There's also quite a growth industry in midwifery circles for claiming breast feeding difficulties and sore nipples on tongue ties, and I'm afraid some maxfac surgeons have also jumped on this lucrative little bandwagon. Tongue tie has nothing to do with narrow arch space and does not affect skeletal development. I agree it would probably be sensible to divide this tongue tie before restoring the missing lower incisors. It can be done very easily under local anaesthetic although, like any other minor op you need to be shown how to do it. There is no risk at all of your patient developing airway obstruction, sleep apnoea, etc, and it doesn't need to be pre-assessed by a galaxy of specialists. Having said which, this is going to be a tricky little implant project in view of the knife-edged ridge. Have you considered a resin bonded bridge?

Analyse airway, airway and airway first, and skeletal facial development !

Sorry digitaldental and Doc, I can't agree. There is simply no risk of airway obstruction following division of a tongue tie such as this. With regard to abnormal skeletal facial development no doubt whoever first posted the question can answer this one. Does your patient have retrognathia, prognathism, a high arched palate, anterior open bite, bilateral molar cross bite, Class II or Class III malocclusion or any other stigmata of abnormal craniofacial growth? I doubt it.

I am an OMFS and this post cracks me up. I am very entertained with the fact that an anterior tongue tie is going to cause the patients tongue to retract and cause obstruction. You will absolutely have to correct the ankyloglossia if you want to reflect and bone graft. I agree with John T about a very difficult area to graft. I would do a chin block graft or a Ti mesh and dissect from a vestibular incision.