Why CO₂ Laser Division Is Chosen for Infants with Tongue-Tie

Tongue-tie, medically known as ankyloglossia, is a congenital oral anomaly in which the lingual frenulum restricts tongue mobility. In some infants, this restriction interferes with breastfeeding, leads to maternal nipple pain, or contributes to poor infant weight gain and feeding difficulties.1Pediatrics

One of the treatment options for symptomatic tongue-tie is frenotomy — a procedure that releases the tight tissue to restore mobility. Traditionally, this has been done with scissors or a scalpel; however, CO₂ laser division has increasingly become a chosen method in many clinics. This post explains why clinicians may prefer CO₂ laser—for neonatal and early infant frenotomies—highlighting evidence and practice-based reasons.

What Is CO₂ Laser Frenotomy?

CO₂ lasers emit light at a wavelength strongly absorbed by water in soft tissue, producing precise ablation with controlled depth and minimal thermal spread. This technology allows clinicians to vaporize restrictive frenulum tissue without direct contact, leading to precise and bloodless incisions.2highhousepedo.com+1

Key Advantages for Infants

1. Precision and Minimal Tissue Trauma

CO₂ lasers enable fine, controlled tissue removal without touching the tissue surface. This level of precision is especially important in infants whose oral structures are tiny and delicate. The laser’s ability to restrict energy to the target tissue can reduce unintended injury to surrounding muscles, nerves, and glands.2highhousepedo.com

2. Reduced Bleeding and Better Visualization

The CO₂ laser simultaneously cuts and coagulates, meaning blood vessels are sealed immediately as tissue is divided. Clinicians report minimal intraoperative bleeding, which is crucial in neonates with low blood volume and limited tolerance for blood loss.1Urbach Pediatric Dentistry

3. Faster Procedures with Less Anesthesia

CO₂ laser frenotomy is often very quick—taking only a few minutes—and may be done with only topical anesthetic in place of stronger sedation or general anesthesia. For infants younger than a few months, minimizing anesthetic exposure is a significant clinical consideration.3rcpi.ie

4. Reduced Risk of Infection and Scarring

The laser’s heat effect sterilizes the operative field as it cuts, which may lower postoperative infection risk. Additionally, less trauma and reduced wound contraction often mean better-organized healing with minimal scarring and reduced risk of functional impairment.4PMC

5. Comfort, Recovery, and Early Feeding

Infants frequently show rapid recovery, immediate or near-immediate breastfeeding improvement, and minimal discomfort post-procedure. The reduced swelling and trauma support quicker return to feeding when compared with more invasive methods.2Falcon Pediatric Dentistry

How CO₂ Laser Compares to Other Methods

While traditional scissors/scalpel frenotomies are still widely practiced and effective, CO₂ lasers offer distinct practical advantages:

• Less collateral heat and deep tissue damage than diode lasers (which operate at much higher temperatures and may cause broader heat spread).2highhousepedo.com

• Better hemostasis and field visibility than cold-steel tools, potentially reducing procedure time and improving accuracy.2LightScalpel

• Often suture-free healing, eliminating a step that can be difficult in infants.4PMC

That said, major pediatric consensus statements (e.g., the American Academy of Pediatrics and American Academy of Otolaryngology–Head and Neck Surgery) note that high-quality comparative evidence is still limited, and recommend that the choice of technique be individualized to the infant’s condition and clinician expertise.5Pediatrics

Evidence and Clinical Reality

Clinical studies and cohort reports suggest that laser frenotomies are safe and effective when performed by experienced clinicians, with minimal complications and good functional outcomes for select infants with feeding problems.6SpringerLink

However, systematic evidence comparing CO₂ laser to other techniques in infants younger than six months is still evolving, and some consensus documents emphasize that no clear superiority has yet been proven.5Pediatrics