Laser Frenectomy: A Possible Alternative for Improving Obstructive Sleep Apnea in Kids?

Last time, we looked at a few of the dental problems that a tongue or lip tie can cause or aggravate. But ties can contribute to other health issues, as well.

Pediatric obstructive sleep apnea (OSA) is one of these. This is a condition in which the airway becomes blocked during sleep, often due to the tongue and jaw falling backward as the body relaxes. The sudden lack of oxygen sends the body’s defense mechanisms into red alert, startling the body awake so the individual can breathe again. These episodes can happen many dozens of times each night.

While the overall incidence is relatively low, it’s considerably higher for children who routinely snore. In fact, snoring – the sound of air being forced past the obstructing tissues – is one of the first signs parents have that something might be wrong. Other times, they may observe their child visibly struggling for air during sleep.

Daytime fatigue and crankiness can also signal that something is wrong, since OSA means a nighttime of constantly disrupted, poor quality sleep.

A fair body of research has shown a link between tongue tie (ankyloglossia) and sleep apnea. In fact, it was the focus of a review published just last month. While only four of nearly 100 previous studies identified met the research team’s criteria, they clearly showed an association.

There is agreement between the four analyzed studies that the lingual frenulum alteration interferes with the growth of anatomical structures, leading to alterations in respiratory, suction, chewing and speech functions.

In simpler terms, the studies showed that the tongue tie changed the way the mouth and face grew, and that led to changes in how people breathed, chewed, and talked.

One study also showed that correcting the tongue tie, in combination with myofunctional therapy, can mean improvement. In this case, the procedure done was a frenuloplasty, which is similar to frenectomy, only the frenulum isn’t removed completely.

Does the same hold true for laser frenectomy, though – the procedure we prefer in most cases because, by removing the tie completely, it maximizes the desired results?

That was the focus of a recent randomized, double-blind clinical trial involving 32 pediatric patients with OSA. Half were randomly assigned to a test group that underwent lingual frenectomies (tongue tie release). The rest underwent myofunctional and speech therapy but no frenectomy. All participants had sleep tests done at the start of the study and three months after treatment to assess their sleep apnea severity and changes over time.

At the start of the study, half of the test group had severe apnea, while the rest had moderate apnea. In the control group, most (81.2%) had moderate OSA, while three kids had severe cases.

By the end of the study, nearly all in the test group – 93.8% – were found to have mild apnea, with the remaining cases being moderate. Results in the control group were quite different. Just 18.75% were found to have mild apnea; in another 18.75%, it had progressed to severe. The remainder had moderate OSA.

The study demonstrates how a lingual laser frenectomy can improve OSAS in pediatric patients.

And it shows how frenectomy can be a real game changer for kids with this life-threatening condition.