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Laser Study by Aetna

Frenectomy or Frenotomy for Ankyloglossia

 

 

Policy

Aetna considers inferior lingual frenectomy or lingual frenotomy for ankyloglossia medically necessary when newborn feeding difficulties or childhood articulation problems exist.

 

Background

Ankyloglossia, or tongue-tie, exists when the inferior lingual frenulum attaches to the bottom of the tongue and restricts its movement. This condition can impair the normal mobility of the tongue and interfere with speech or newborn feeding.

 

If the tongue can touch the anterior dentition, mobility is adequate for the development of normal speech. However, in situations where the inferior lingual frenulum significantly impedes tongue excursion, a frenulectomy may be performed in order to free the tongue.

 

An assessment by the National Institute for Health and Clinical Excellence (NICE, 2005) concluded that “current evidence suggests that there are no major safety concerns about division of ankyloglossia (tongue-tie) and limited evidence suggests that this procedure can improve breastfeeding”.

 

Aras and colleagues (2010) compared the tolerance of lingual frenectomy with regard to a local anesthesia requirement as well as post-surgical discomfort experienced by patients operated on with diode laser or erbium: yttrium-aluminum-garnet (Er:YAG) Laser. A total of 16 referred patients with tongue mobility complaints were included in this study. A GaAiAs laser device with a continuous wavelength of 808 nm was used in the diode group. Frenulums were incised by applying 2W of laser power. The Er:YAG laser device with a continuous wavelength of 2,940 nm was used inEr:YAG group. Frenulums were incised by applying 1W of laser power. The acceptability of the lingual frenectomy without local anesthesia and the degree of the post-surgical discomfort were evaluated. Although the majority of patients (n = 6) could be operated on without local anesthesia in theEr:YAG group, all patients could not be operated on without local anesthetic agent in the diode group. There were no differences between the 2 groups with regard to pain, chewing, and speaking on the 1st or 7th day after surgery, whereas patients had more pain in the Er:YAG group  than in the diode group the first 3 hrs after the surgery. The authors concluded that these findings indicate that only the Er:YAG laser can be used for lingual frenectomy without local anesthesia, and there was no difference between 2 groups regarding the degree of the post-surgical discomfort except in the first 3 hrs. Thus, these results indicate that the Er:YAG laser is more advantageous than the diode laser in minor soft-tissue surgery because it can be performed without local anesthesia and with only topical anesthesia.

 

Buryk et al (2011) noted that ankyloglossia has been associated with a variety of infant-feeding problems and that frenotomy commonly is performed for relief of ankyloglossia. The investigators conducted a randomized, single-blinded, controlled trial to determine whether frenotomy for infants with ankyloglossia improved maternal nipple pain and ability to breastfeed.  A secondary objective was to determine whether frenotomy improved the length of breastfeeding. Over a 12-month period, neonates who had difficulty breastfeeding and significant ankyloglossia were assigned to either a frenotomy (30) infants or a sham procedure (28 infants) and breastfeeding was assessed by a pre-intervention and post-intervention nipple-pain scale and the Infant Breastfeeding Assessment Tool. Study subjects were followed two weeks post-procedure and at regularly scheduled follow-ups over one year period. The infants with the sham group were given a frenotomy before or at the 2-week follow-up if it was desired. Both groups demonstrated statistically significantly decreased pain scores after the intervention, but the frenotomy group improved significantly more than the sham group (P < .001). Breastfeeding scores significantly improved in the frenotomy group (P = .029) without a significant change in the control group. All but 1 parent in the sham group elected to have the procedure performed when their infant reached 2 weeks of age, which prevented additional comparisons between the 2 groups. The investigators demonstrated immediate improvement in nipple-pain, which they state provides convincing evidence for those seeking a frenotomy for infants with significant ankyloglossia.

 

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