Tanı Sürecinden Cerrahi Müdahaleye Uzanan Yol: Pediatrik Frenektomi Üzerine Kapsamlı Bir Derleme

Abstract

Frenulum, oral kavitede dil ve dudak hareketlerini destekleyen önemli bir anatomik yapıdır. Çocukluk döneminde frenulumun anormal gelişimi; konuşma bozuklukları, beslenme güçlükleri ve ortodontik anomaliler gibi çeşitli klinik problemlere yol açabilmektedir. En sık karşılaşılan frenulum anomalileri arasında ankiloglossi (dil bağı) ve hipertrofik labial frenulum yer almakta olup, bu durumların tedavisinde frenektomi adı verilen cerrahi işlem uygulanmaktadır. Frenektomi, anormal frenulumun eksizyonu veya yeniden şekillendirilmesini içeren bir girişimdir ve oral fonksiy6 onların iyileştirilmesi ile kraniofasiyal gelişimin desteklenmesini amaçlamaktadır. Son yıllarda, geleneksel cerrahi tekniklere ek olarak lazer destekli frenektomi gibi minimal invaziv yaklaşımlar giderek yaygınlaşmıştır. Lazerle gerçekleştirilen uygulamalar; daha az kanama, minimal postoperatif ağrı ve daha hızlı iyileşme gibi avantajlar sunmakta ve çocuk hasta grubunda hasta konforunu artırmaktadır. Bu derlemede, çocuk diş hekimliğinde kullanılan farklı frenektomi teknikleri; klinik endikasyonlar, etkinlik, avantajlar ve sınırlılıklar açısından değerlendirilerek, güncel literatür ışığında kısa ve uzun vadeli etkileriyle birlikte tartışılacaktır. Ayrıca, geleneksel ve modern yaklaşımlar karşılaştırılarak çocuk hastalar için en uygun tedavi seçenekleri ortaya konulacaktır.

Keywords

• Ankiloglossi
• frenektomi
• labial frenulum
• lazer frenektomi
• çocuk diş hekimliği

From Diagnosis to Surgical Intervention: A Comprehensive Review of Paediatric Frenectomy

Abstract

The frenulum is an essential intraoral structure that facilitates the coordinated function and mobility of the tongue and lips. During childhood, abnormal development of the frenulum may result in various clinical complications, including speech disorders, feeding difficulties, and orthodontic anomalies. Among the most frequently observed anomalies are ankyloglossia (tongue-tie) and hypertrophic labial frenulum, which are commonly managed through a surgical procedure known as frenectomy. Frenectomy involves the excision or reshaping of the aberrant frenulum and aims to enhance oral functions and support proper craniofacial development. In recent years, minimally invasive techniques such as laser-assisted frenectomy have gained popularity as alternatives to conventional surgical methods. These laser-based procedures offer several clinical advantages, including reduced intraoperative bleeding, minimal postoperative discomfort, and accelerated wound healing, thereby improving the overall patient comfort in paediatric populations. This narrative review examines the clinical indications, efficacy, benefits, and limitations of various frenectomy techniques used in paediatric dentistry. Furthermore, conventional and modern approaches were compared to identify the most suitable treatment strategies for paediatric patients based on current scientific evidence

Keywords

• Ankyloglossia
• frenectomy
• labial frenulum
• laser frenec6 tomy
• paediatric dentistry

References

1. Chaubey KK, Arora VK, Thakur R, NaruLa IS. Perio-esthetic surgery: Using LPF with frenectomy for prevention of scar. J Indian Soc PeriodontoL 2011;15(3):265-9. google scholar
2. Haham A, Marom R, MangeL L, Botzer E, DoLLberg S. PrevaLence of breastfeeding difficuLties in newborns with a LinguaL frenuLum: A prospective cohort series. Breastfeed Med 2014;9(9):438-41. google scholar
3. Ishikawa I, Aoki A, Takasaki AA, Mizutani K, Sasaki KM, Izumi Y. AppLication of Lasers in periodontics: True innovation or myth? PeriodontoL 2000 2009;50(1). google scholar
4. Fiorotti RC, BertoLini MM, Nicola JH, NicoLa EM. EarLy LinguaL frenectomy assisted by CO2 Laser heLps prevention and treatment of functional aLterations caused by ankyLogLossia. Int J Orofac MyoL 2004;30(1):64. google scholar
5. Mills N, Keough N, Geddes DT, Pransky SM, MirjaLiLi SA. Defining the anatomy of the neonatal Lingual frenulum. Clin Anat 2019;32(6):824-35. google scholar
6. Mills N, Geddes DT, Amirapu S, Mirjalili SA. Understanding the LinguaL frenuLum: Histological structure, tissue composition, and impLications for tongue tie surgery. Int J Otolaryngol 2020;2020(1):1820978. google scholar
7. O'Shea JE, Foster JP, O'Donnell CP, Breathnach D, Jacobs SE, Todd DA, et aL. Frenotomy for tongue-tie in newborn infants. Cochrane DataBase Syst Rev 2017(3). google scholar
8. Placek M, Skach M, MrkLas L. ProbLems with the Lip frenuLum in parodontoLogy. I. CLassification and epidemioLogy of tendons of the Lip frenuLum. Cesk StomatoL 1974;74(5):385-91. google scholar

9. Kinney R, Burris RC, Moffat R, ALmpani K. Assessment and management of maxillary Labial frenum-A scoping review. Diagnostics 2024;14(l6):1710. google scholar
10. ıo Coryllos E, Genna CW, SaLLoum AC. Congenital tongue-tie and its impact on breastfeeding. In: Lawrence RA, Lawrence RM, editors Breastfeeding: A guide for the medicaL profession 6th ed PhiLadeLphia: Mosby; 2005 p 311-5.1-6. google scholar
11. Narsat MA, Beygirci A, Özdönmez GT, Yıldız E. Grouping of ankyLogLossia according to coryllos anatomical cLassification and follow-up resuLts for breastfeeding: Single-center, cross-sectional study. ChiLdren 2022;9(l2):1860. google scholar
12. Huang W-J, Creath CJ. The midLine diastema: A review of its etioLogy and treatment. Pediatr Dent 1995;17:171-. google scholar
13. Yadav RK, Verma UP, Sajjanhar I, Tiwari R. Frenectomy with conventionaL scaLpeL and Nd: YAG Laser technique: A comparative evaLuation. J Indian Soc PeriodontoL 2019;23(l):48-52. google scholar
14. Baxter R, MerkeL-WaLsh R, Lahey L, Knutsen C, Zaghi S. The buccaL frenum: Trends in diagnosis and indications for treatment of buccaL-ties among 466 heaLthcare professionaLs. J Oral Rehabil 2024;5l(2):369-79. google scholar
15. Singh D, AgrawaL S. Review of Literature. In: AgrawaL S, Tiwari PK, Singh D, Singh K, Kumari P, Pandey PK, editors. Ortho-Perio Interrelationship. New DeLhi: BFC PubLications; 2021. p. 15-35. google scholar
16. Haytac MC, OzceLik O. EvaLuation of patient perceptions after frenectomy operations: A comparison of carbon dioxide Laser and scaLpeL techniques. J PeriodontoL 2006;77(ll):1815-9. google scholar
17. Pie-Sânchez J, Espana-Tost AJ, Arnabat-Domınguez J, Gay-Escoda C. Comparative study of upper Lip frenectomy with the CO2 Laser versus the Er, Cr: YSGG Laser. Med OraL PatoL OraL Cir BucaL 2011;17(2):e228. google scholar
18. Rai AA, SaLian SS, Dhadse PV, PatiL RT, Punse SD, PaLeriya KM. Labial frenectomy using conventionaL scalpel technique: A case report. Cureus 2024;16(7). google scholar
19. Endang S, Mardiana AA, Djais AI, Nardiatmo SS, Putri SW. Z pLasty-an aesthetic surgery for aberrant Labial frenum: A case report. KnE Med 2022:144-50. google scholar
20. Protasio ACR, Galvao EL, Falci SGM. Laser techniques or scalpel incision For labial Frenectomy: A meta-analysis. J MaxilloFac Oral Surg 2019;18:490-9. google scholar
21. Onur SG. Evaluation oF pain perception and wound healing aFter laser-assisted Frenectomy in pediatric patients: A retrospective comparative study. Photobiomodul Photomed Laser Surg 2021;39(3):204-10. google scholar
22. Shang J, Han M, Sun J, Xu D, Qu W. Comparative study on the treatment oF ankyloglossia by using Er: YAG laser or traditional scalpel. J CranioFac Surg 2021;32(8):e792-e5. google scholar
23. Öztürk Özener H, Meseli SE, Sezgin G, Kuru L. Clinical eFficacy oF conventional and diode laser-assisted Frenectomy in patients with diFFerent abnormal Frenulum insertions: A retrospective study. Photobiomodul Photomed Laser Surg 2020;38(9):565-70. google scholar
24. Messner AH, Lalakea ML. Ankyloglossia: Controversies in management. Int J Pediatr Otorhinolaryngol 2000;54(2-3):123-31. google scholar
25. Melong J, Bezuhly M, Hong P The eFFect oF tongue-tie release on speech articulation and intelligibility. Ear Nose Throat J 2024;103(7):NP450-NP4. google scholar
26. Genna CW. The influence oF anatomic and structural issues on sucking skills. In C W Genna (Ed), Supporting sucking skills in breastFeeding inFants (4th ed, pp 197-242) Jones & Bartlett Learning 2022:197-242. google scholar
27. Naini FB, Gill DS. Oral surgery: Labial Frenectomy: Indications and practical implications. Br Dent J 2018;225(3):199-200. google scholar
28. American Academy oF Pediatric Dentistry. Policy on management oF the Frenulum in pediatric patients. The ReFerence Manual oF Pediatric Dentistry. Chicago, İli.: American Academy oF Pediatric Dentistry; 2024:73-8. google scholar
29. IAPD Foundational Articles and Consensus Recommendations: Management oF Ankyloglossia, 2022. http://www.iapdworld.org/2022_04_management-oF-ankyloglossia. google scholar
30. Srinivasan A, Al Khoury A, Puzhko S, Dobrich C, Stern M, Mitnick H, et al. Frenotomy in inFants with tongue-tie and breastFeeding problems. J Hum Lact 2019;35(4):706-12. google scholar
31. Wongwattana P The eFFect oF Frenotomy on long-term breastFeeding in İnFants with ankyloglossia. İnt J Pediatr Otorhinolaryngol 2022;152:110983. google scholar
32. Tadros S, Ben-Dov T, Cathain EO, Anglin C, April MM. Association between superior labial Frenum and maxillary midline diastema-a systematic review. Int J Pediatr Otorhinolaryngol 2022;156(111063):10.1016. google scholar
33. Kotlow LA. Diagnosing and understanding the maxillary lip-tie (superior labial, the maxillary labial Frenum) as it relates to breastFeeding. J Hum Lact 2013;29(4):458-64. google scholar
34. Srinivasan B, Chitharanjan AB. Skeletal and dental characteristics in subjects with ankyloglossia. Prog Orthod 2013;14:44. google scholar
35. Rajani E, Biswas P. Maxillary labial Frenum and malocclusion: An overriding or an overlooked tissue. Int J Oral Health Dent 2022;8(2):139-46. google scholar
36. Madi M, Alamri A, Aleisa D, Omar Almusallam M, Saeed AlQahtani S, Al-Aql ZS, et al. Associations between maxillary labial Frenum morphology, attachment, and patient-related clinical Factors in Saudi Arabian adults: Cross-sectional study. Saudi Dent J 2024;36(4):615-20. google scholar
37. Wheeler B, Carrico CK, ShroFF B, Brickhouse T, Laskin DM. Management oF the maxillary diastema by various dental specialties. J Oral MaxilloFac Surg 2018;76(4):709-15. google scholar
38. Ahn JH, Newton T, Campbell C. Labial Frenectomy: Current clinical practice of orthodontists in the United Kingdom. Angle Orthod 2022;92(6):780-6. google scholar
39. Tanık A, Çiçek Y. Evaluation of the distance between the central teeth after frenectomy: A randomized clinical study. Eur Oral Res 2021;55(2):996103. google scholar