Posterior Tongue Tie

An ordinary garden-variety tongue tie (also known as ankyloglossia) is a rare condition whereby the tongue is anchored to the floor of the mouth preventing the tongue tip from moving freely.

Patients with tongue tie have greater difficulty with:

• feeding if infant
• speech if school-age child
• french kissing if young adult

Treatment is tongue tie release which can be done at any time if difficulties arise. In infants and young adults, this procedure can be done in the office under local anesthesia only. In school age kids, it typically requires sedation given lack of cooperation with keeping the mouth open and tongue still.

Posterior Tongue Tie

Though tongue tie is rare, there is an even more rare subtype called submucus tongue tie or posterior tongue tie.

This condition is when the tongue tie is hidden UNDER the mucus lining of the tongue/mouth. You can't see this type of tongue tie, but you can feel it if you run the finger underneath the tongue from side to side where the tongue tie would be. One would feel a tissue band (speed-bump sensation with finger sweep) where the tongue tie would be.

Treatment is a bit more complicated than a regular tongue tie release in that the mucus lining has to be incised in order to expose the tongue tie prior to release. Once the tongue tie is released, the incision is sutured closed.

Given the more complicated steps to address this rare condition, it does need to be performed under sedation.

Gluing Cut Blood Vessels Together

Gluing blood vessels together, just like gluing a cut garden hose together, does not seem like a great idea at first, but Stanford researchers just might have figured out how to do this safely and effectively.

Over the past century and still currently used today is to hand-sew the cut ends of the blood vessel together using stitches. This method of reattaching blood vessels is time-consuming and tedious, especially when the blood vessels are tiny.

In this new glue method which is FIVE times faster, a special substance is injected into the cut blood vessel on both ends called a poloxamer. This substance has the unique property of becoming an elastic solid when heated above body temperature which than turns into a biodegradable liquid that dissolves away when cooled.

In a nutshell, the steps are as follows:

1. The poloxamer is inserted into the blood vessel where is solidifies using a halogen lamp thereby keeping the lumen open.


2. The cut edges of the blood vessel are precisely reapproximated and "glued" together using dermabond, a substance currently used to "glue" together cut skin.


3. The blood vessel is allowed to cool down by taking away the halogen lamp and the poloxamer contained within the blood vessel melts and dissolves away.

So far, this procedure has only been done in animals, but since all of the components of this technique has already been FDA-approved for human use for other purposes, if proven to work, can rapidly be adopted for microvascular surgery in humans.

Reference:
Vascular anastomosis using controlled phase transitions in poloxamer gels. Nature Medicine (2011) doi:10.1038/nm.2424

Welding a Cut Nerve Together Using a Laser

Although preliminary, researchers have successfully "welded" a cut nerve together using a laser rather than traditional suture repair.

When a nerve is cut, the only way to allow potential for the nerve to regain function is to bring the cut edges together and hope nerve regeneration crosses over. Traditionally, this was pain-stakingly accomplished under the microscope using sutures as thin as a human hair.

Using the rabbit facial nerve, researchers used a laser to weld the cut nerve edges together rather than using sutures and demonstrated a trend towards superior outcomes. Not only was the outcome better, it was way easier and faster to perform.

This new technique has tremendous application in ENT surgery, but can also apply to any surgery where nerves can get damaged or cut... vocal cord paralysis from thyroid surgery (recurrent laryngeal nerve), unable to lift shoulder from neck dissection (accessory nerve), facial paralysis from parotid gland tumor resection (facial nerve), etc, etc.

Reference:
Laser Facial Nerve Welding in a Rabbit Model. Arch Facial Plast Surg. Published online August 15, 2011. doi: 10.1001/archfacial.2011.61