For newborns, frenectomy can be performed in the office without anesthesia or sedation. Dr. Wei performs an in-office procedure using a sterile scissor and silver nitrate sticks to stop the bleeding, if needed; no sutures are needed.
Explore This IssueSeptember 2019
Lasers are more commonly used by dentists, who may charge $800 or more to treat a tongue tie, Dr. Messner noted. But the use of lasers can be dangerous. “As a pediatric otolaryngologist, I have seen burn injuries as a result of laser therapy; therefore, I would personally not use lasers on any newborn,” Dr. Wei said. Once an infant is older than six months, it is more difficult to perform a frenectomy in the office.
For toddlers and school-aged children, lingual frenotomy is generally performed under brief mask general anesthesia. “Having the child under sedation allows me to be precise, release as much as necessary, and place a few dissolvable stitches to bring together the edges of the mucosa instead of waiting for that raw area to heal by secondary intention and risk scar band reforming,” Dr. Wei said.
There are some downsides to the procedures. There are rare incidences of persistent bleeding, damage to the salivary ducts, or oral aversion due to pain in the baby’s mouth. “That is why many otolaryngologists are opposed to lasers. Nipping [the tie] with the scissor is kinder and likely to have fewer complications,” Dr. Messner said.
One thing that many professionals appear to agree on is the need for more research. “The data on the benefits of treating tongue tie are very weak. Much is being talked about in this area and there is a lot of controversy, yet there are no large, well-controlled studies; we need more standardization on the definitions and how to measure outcomes,” Dr. Balakrishnan said.
“Each surgeon must rely on their experience, knowledge, [and] careful exam, and discuss with the family what’s truly reasonable and if that were their own child, would they ‘cut’ anything,” Dr. Wei said.
To address the controversy, the American Academy of Otolaryngology–Head and Neck Surgery is producing a consensus report to be released at the annual meeting in New Orleans on September 15, 2019. The American Academy of Pediatrics is also working on a consensus statement.
Nikki Kean is a freelance medical writer based in New Jersey.