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Click here for phone consultation and appointment. You will meet directly with Oytun İdil.
Rumeli cad. No:3 D:1 Nişantaşı, Şişli - İstanbul / Türkiye
Surgery
Tongue reduction surgery (regardless of whether the patient is an adult or a child) is always performed under general anesthesia. In adult patients, anesthesia is usually given through a tube inserted through the nose. In infant patients, anesthesiologists and otolaryngologists consult and decide whether a tracheostomy (a breathing hole through the larynx) should be opened for the baby. In infant patients, the tracheostomy can be opened before surgery and remain like this for a while. The tracheostomy is closed at a later date.
The plan of the surgery depends on the patient's needs, age and occupation. In this surgery, the technique of the surgery is not difficult. The decisions to be taken for the surgery and the management of the patient are difficult. The patient needs to be handled appropriately and operated on by making the right decisions. These also require experience.
Plans for surgery:
There are different surgical plans for tongue reduction around the world. You can see many of them below. The red colored areas in the drawings are the areas removed.
Some of the following surgical plans only narrow the tongue, some only shorten it. Some surgical plans disrupt the taste function of the tongue. Techniques such as these have been tried throughout history and many have been abandoned because of the problems they cause.
Our preferred surgical technique is the "Egyedy" technique. With this technique, the taste functions of the tongue are not impaired, the nerves of the tongue are protected, and both shortening, narrowing and thinning are possible. In our opinion, the best technique is the "Egyedy" surgical plan.
Technical detail: Of the above surgical techniques, those that reduce the tongue from the middle of the tongue are better. Important nerves of the tongue come from the right and left sides. These nerves may be injured in surgeries performed on the sides of the tongue. Movement of the tongue and taste functions may be impaired. Therefore, techniques such as Egyedy, which reduces the tongue from the center, are safe.
We prefer the "Egyedy surgery plan" as an operation plan; because with this plan, the taste function of the tongue is not affected. The nerves and blood vessels of the tongue are protected. In addition, the tongue can be both narrowed and shortened as we wish. Thinning can also be done if desired. Also, at the end of the surgery, when the stitches are removed, the result looks very natural.
If you look at the taste areas of the tongue, you will see that the surgery does not affect the taste function of the tongue.
Will there be a scar after the surgery?
In tongue reduction, all stitches are placed on the tongue. The tongue tissue heals very quickly and well. All stitches dissolve and fall off within 2-3 weeks after the operation. After the suture lines heal, there is no visible scar left. If the surgery is planned well, we can say that there is no scar left after the surgery as the appearance of the tongue will be very natural.
General information:
Many patients apply to us for this surgery at an adult age, before orthodontic treatment. In many patients with a large tongue since childhood, the teeth develop malformed due to the pushing of the tongue. In these patients, the teeth usually grow inclined outwards due to the tongue pushing from the back. The patient goes to an orthodontist to correct the posture of their teeth. The orthodontist first wants the tongue to be reduced and sends the patient to us. In these patients, orthodontic treatment is started after the tongue, which pushes the teeth outwards, is reduced.
Some patients are born with a large tongue due to genetic disorders (for example Down syndrome and Beckwith-Wiedemann syndrome). These patients are usually brought to us as babies or children. In very severe cases, the tongue can be so large at birth that it can make breathing difficult. These patients may require urgent intervention. In pediatric patients, if the situation is so urgent, the patient may need a tracheostomy. A tracheostomy is when a hole is made in the throat and anesthesia is administered through it. This operation is very risky because the patient is a newborn and a tracheostomy is needed. It is possible that the patient (baby) may die, but it is also true that if the patient is not operated on, he/she will die because he/she cannot breathe. For babies whose condition is not so urgent, it is recommended to wait 3-4 months and perform surgery. If the excessively large tongue continues after the age of 1 year in babies, it disrupts the jaw and tooth structure and impairs speech. Therefore, the best time for surgery in infant patients whose condition is not very urgent is between 3 months and 1 year of age. Depending on the size of the tongue, surgery can be delayed until safer anesthesia can be given. It takes experience to decide this. A surgeon experienced in tongue reduction makes the right decisions and ensures that the patient is treated in the most appropriate way. Thus, the tongue is reduced in the most appropriate way without causing jaw and tooth development disorders and without impairing speech. The movement of the tongue (speech function) and taste function are not affected.
In pediatric patients, tongue size is usually congenital. Speech is impaired in these patients. Therefore, they usually need speech therapy after tongue reduction. Speech improves over time.
Adult patients sometimes require very special attention. Especially the diction of patients who are actors, presenters and television personalities is very important. Such patients sometimes apply to us. Generally, the complaints of these patients are that they have difficulty in making certain sounds because the tongue is too long or wide. Other than that, their diction is perfect. In these patients, the tongue is shortened or narrowed according to the need. In the meantime, the patient's diction should not be disturbed. After the operation, the patient's diction should be as smooth as before.
How is the surgery performed?
In the operation, the tip of the tongue is sutured with a thick surgical thread and the tongue is pulled out. A drawing is made on the tongue according to the operation plan. A medication that prevents bleeding is injected into the incision lines. According to the plan, the part to be removed is removed and the rest of the tongue is sutured in several layers.
Sometimes the tongue is thicker than normal in these patients. It is also necessary to thin the tongue. In this case, the surgeon must make a decision with his/her experience. Can thinning and shortening of the tongue be performed in the same session or should thinning be performed in a separate session? In some cases, some thinning can also be performed during shortening and narrowing. Sometimes the tongue is too thick and thinning needs to be done along the entire tongue, in which case it is more appropriate to do the thinning in a separate session.
If the cause of the patient's speech disorder is not only a large tongue but also a short sublingual ligament, the sublingual ligament must be cut during the operation. In fact, this sublingual ligament is both cut and lengthened. In this way, the tongue is kept in the mouth and the tongue is left free enough for the patient to make sounds.
In surgery, all bleeding must be stopped before stitches are applied. It should not be forgotten that the tongue is a tissue that bleeds a lot. It is very important to completely burn and stop the bleeding. Stitches should be placed with stitches that dissolve in the long term. Quick-dissolving sutures are not used in the tongue. If fast-dissolving sutures dissolve early with the effect of salivary enzymes in the mouth, the sutures may open. Therefore, sutures that dissolve late are used. Stitches do not need to be removed. After the suture line heals, the threads will melt and fall off.
IS THERE ANY OTHER WAY TO REDUCE THE SIZE OF THE TONGUE OTHER THAN SURGERY?
In some scientific articles, it is written that the tongue can also be reduced by applying radiofrequency in addition to surgery. However, with this technique, the movement function of the tongue will be affected because the entire muscle structure of the tongue will be affected. This disrupts the movement of the tongue. Therefore, speech is impaired. Apart from this, the taste function is impaired. In addition, radiofrequency application will not shrink the tongue sufficiently. The fact that it is not controlled is another problem. You cannot only narrow the tongue with radiofrequency, or only shorten it. It is only possible with surgery to make the tongue exactly as narrow or as short as desired. For this reason, radiofrequency tongue reduction is not currently practiced routinely.
In scientific articles it is written that one way to reduce the size of the tongue is to peel off the outer surface of the tongue. However, this technique completely destroys the taste function of the tongue. Therefore, this technique is also not practiced.
It is only possible with surgery to narrow and shorten the tongue exactly as much as desired without disrupting the speech and taste functions of the tongue.
After the surgery:
No dressing is applied at the end of the surgery. The patient should use mouth disinfectant for one week and antibiotics for five days. The patient should be fed with grain-free, watery foods for 2 days (grain-free soup, yogurt, fruit juice, etc.). On the third day, normal food is gradually introduced. During the first five days, it will be good for the patient to talk as little as possible. Thus, the stitches will heal more easily as there will be less tongue movements.
Adult patients may be discharged after surgery or hospitalized overnight depending on the size of the tissue removed from the tongue.
Pediatric and infant patients are kept in hospital for at least 1 day. Especially infant patients may be difficult to feed after surgery. The baby should be fed with a spoon and watery food by its mother.
If patients are going to start orthodontic treatment, orthodontic treatment can be started 2 weeks after surgery.
In some cases, it may be necessary to perform a second surgery to reduce the size of the tongue in the future. For example, if the size of the tongue is due to lymphangioma, the tongue may grow again after the tongue reduction surgery and it may be necessary to reduce the tongue again in the following years.
Stitches do not need to be removed. The threads will dissolve and fall out on their own in due time. The patient does not even notice.
Although the surgical site is in the mouth, infection is not a common complication. Infection does not occur if the patient uses mouth disinfectant properly and takes antibiotics on time.
These patients are usually sent home 1-2 days after surgery and are not called for follow-up anytime soon. In recent years, we communicate with our patients via whatsapp. Our controls are also usually done via whatsapp. Our patients can ask us questions and send photos via whatsapp at any time. Since Dr. Oytun idil communicates directly with his patients via his own mobile phone, these messages are both fast and patients are in direct communication with the surgeon performing their surgery. Dr. Oytun idil's personal mobile numbers are +90 533 5690649 and +90 505 2965569 and these numbers have not changed since 2000. You can communicate via Whatsapp on +90 533 5690649...
Patient satisfaction is very high in this surgery. It is a surgical procedure that increases the comfort of life of patients and has an extremely low probability of complications.
KEY POINTS
- The patient's needs must be precisely determined (will there be a need for thinning, shortening, or both of them???)
- It is necessary to make sure that the patient is a suitable case for this surgery (will it solve the tongue reduction problems?)
- Is there a need for any additional intervention (thinning of the tongue, cutting the sublingual ligament, etc.) If the sublingual ligament is short, this can impair speech. If necessary, the sublingual ligament can also be cut during tongue reduction surgery.
- Will the patient need speech therapy after the surgery? If necessary, he/she should be sent to a speech therapist
- The biggest mistake that can be made in surgery is over-reducing the tongue. The surgical plan should be made well and the tongue should never be reduced more than necessary. Remember, an insufficiently reduced tongue can be reduced to the desired size with a small additional surgical intervention, but it is not possible to enlarge an over-reduced tongue.
- When making the surgical plan, a plan that will minimize the taste sensations of the tongue should be made. We generally prefer the Egyedy & Obwegeser drawing among many surgical plans. With this surgical plan, the tongue can be shortened and narrowed as much as desired. In addition, the taste functions of the tongue are not affected much.
- After surgery, it is important to make sure that the patient uses mouth sanitizer and antibiotics properly.
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Op. Dr. Oytun İdil (Plastic & reconstructive surgeon)
Address: Rumeli cad. No:3 D:1 Nişantaşı, Şişli - İstanbul / Türkiye
E-mail: oytunmd@gmail.com
GSM: +90 533 569 0649 +90 505 296 5569 +90 553 985 8087
Office: +90 212 296 3656 +90 505 137 1393
Whatsapp: +90 533 569 0649 +90 553 985 8087
