21 March 2021

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Lingual frenectomy, post operative complications : A critical review

Giulia Palandrani

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Ankyloglossia (ankylos – curved/tied; glossa – tongue), also known as tongue-tie, is an embryological anatomical malformation of the tongue, characterized by an abnormally short and thick lingual frenum with restricted tongue movement. 

Ankyloglossia is commonly observed in infants with an incidence rate of about 5%. Individuals with tongue-tie are unable to protrude the tip of the tongue beyond the mandibular incisor region or touch the palate. 

A short and fibrotic lingual frenum in infants can cause functional problems such as breastfeeding difficulty, delayed development or deterioration of speech, altered chewing and swallowing pattern, mouth breathing, aerophagia, risk of developing class III malocclusions with reduced maxillary growth and mandibular prognathism. Therefore, surgical correction of aberrant lingual frenal attachment is essential to overcome these mechanical limitations and functional challenges. 

The most common method to correct ankyloglossia is by the surgical excision of aberrant frenal attachments by the process known as frenotomy, frenectomy or frenuloplasty 

Even though the process of lingual frenectomy is simple, the anatomical location and topography of the lingual tissue make it vulnerable to various postoperative and intraoperative complications. This paper aims to highlight the common etiology associated with various intra and postoperative complications with this surgical procedure. 

Material and methods 

The following search terms were used for data collection: ‘’lingual frenectomy AND Complications’’ and ‘‘Ankyloglossia AND Complications’’. 

The inclusion criteria for selecting articles include the type of article (randomized clinical trial comprising of longitudinal study design, cohort study, case-control study, and cross-sectional study), sample size, the statistical and clinical significance of the outcome, randomization and blinding. Case reports and case series were not included. 

Around 154 articles were screened for review. Only 20 articles fulfilled the above-mentioned inclusion and exclusion criteria were included for review. 

Results

The complications following lingual frenectomy can be classified as follows: complications that arise immediately to few hours following surgery (intraoperative or immediate complications), and complications that arise few days to weeks after surgery (postoperative or delayed complications).

Excessive bleeding or hemorrhage due to injury to the submental and sublingual artery and deep lingual veins 

Formation of retention cyst or ranula, its etiology is a partial blockage of Wharton’s duct while suturing or injury while delivering local anesthesia

Sublingual hematoma formation caused by an extravasation of blood into the tissue spaces between the muscles of the tongue and floor of the mouth.

Development of sublingual and submandibular space infection due to microbial contamination of the site due to faulty and deep surgical incisions or infected suture material or systemically immuno-compromised patients with poor wound healing capacity

Reattachment or recurrence of frenal attachment caused by development of a fibrous scar at the site of the excision or inadequate releasing incisions and incomplete removal of frenal attachment at the time of lingual frenectomy.

Development of new speech disorder or worsening of existing speech disorder caused by restricted movement of the lingual frenum following surgery especially due to scar tissue formation 

Numbness and paresthesia of the tongue and neighboring soft tissues with multiple etiology: direct and indirect injury to the lingual nerve during incision, pressure from healing wound and postsurgical edema, movement of the needle itself, extra or intraneural hemorrhage from trauma to nearby blood vessels or the neurotoxicity of the used anesthetic site with anesthetic agents can induce nerve injury following lingual frenectomy.

Conclusions

Although lingual frenectomy is a common and technique sensitive surgical procedure, the anatomic and topographic lingual frenum makes the site vulnerable to various intraoperative and postoperative complications. Therefore, comprehensive knowledge and understanding of the various etiology of complications associated with lingual frenectomy are essential to provide optimal postoperative care and achieve good clinical outcomes and overall patient satisfaction. 

For additional information: Etiology and clinical recommendations to manage the complications following lingual frenectomy: A critical review.