Bipolar scissor division of tongue-tie under tubeless anesthesia.

Abstract

Children with tongue-tie are frequently referred to the otolaryngologist. The usual reasons for consultation are associated mechanical problems, speech difficulties, parental concern about the tongue's appearance and, occasionally, suckling problems in infants. Tongue-tie has been accurately defined by Wallace1 as “a condition in which the tip of the tongue cannot be protruded beyond the lower incisor teeth because of a short frenulum linguae.” It may vary in degree from a very mild form in which the tongue is bound only by a thin mucous membrane and an intermediate form, in which both the frenulum and the underlying fibers of the genioglossus muscle are fibrosed, to the rare variety termed “ankyloglossia” in which the tongue is completely fused to the floor of the mouth.2, 3 Data in the literature suggest that the incidence of tongue-tie ranges from 0.03% in newborns to 0.4% in 4-to 5-year-old children presenting to a speech disorders clinic.4, 5 When indicated, tongue-ties are usually divided with the patient under general endotracheal anesthesia and with the use of scissors followed by hemostasis with sutures or diathermy. We introduce a method for tongue-tie division using scissors that cut and induce bipolar coagulation at the same time. The procedure is performed with the patient under tubeless anesthesia because of the complete hemostasis obtained when using these scissors. General anesthesia is induced using intravenous propofol in a dose of 2.5 mg/kg. A McKesson Dental Prop (Wright Health Group, Dundee, Scotland, UK) is used to hold the mouth open, and the tongue is grasped with a surgical swab or toothed forceps. The frenulum is divided with PowerStar Bipolar Scissors (Ethicon, Inc., Somerville, NJ) using a slow cutting movement and the simultaneous current application of 25 W (Fig. 1). The cutting stops short of the genioglossus muscle, which is not divided. Usually, only one snip is required and no bleeding occurs. A face mask supplying 100% oxygen is applied until the child is awake (Fig. 2). The child is discharged later, when able to eat. Division of tongue-tie with bipolar scissors. We have used this technique in six patients without any morbidity. Surprisingly, there was very little discomfort following the procedure and they were all able to go home shortly after surgery. On follow-up a month later, the tongue had gained a good range of mobility, and there were no parental concerns in the intervening period. Child with a face mask applied after the procedure. PowerStar bipolar scissors were introduced in 1997 for use in open surgery. The two blades are insulated from each other to form the active electrodes of the bipolar instrument. The handles and part of the outer surface of the blades are covered with plastic. The pairs we describe are a modification for use in the oral cavity with extended insulation to prevent oral cavity burns (Fig. 3).6 After 30 to 40 operations the blades become blunt; the scissors should then be discarded. Using dual-function scissors provides a completely bloodless operating field and therefore has advantages over the traditional method in many ways. The most important is the ability to perform the procedure with the patient under tubeless anesthesia, which has fewer complications and is associated with a speedy recovery. The operation itself is easier and more precise because of the lack of bleeding during tongue-tie division. Modified bipolar scissors. We have found this technique to be safe, with advantages over other methods. We recommend it to surgeons who perform tongue-tie division.