Do you remember in the film “Pokrovsky Gate” the characteristic female surgeon with her famous phrase “Cut!.. without waiting for peritonitis”? So the same thing often happens to the poor bridle. However, as experience shows, there is not always only one way out. Not every case of the so-called “short frenulum” requires radical measures.
What is a short frenulum of the tongue?
The frenulum is a thin partition that connects the tongue and the lower oral cavity. Normally, the frenulum is quite elastic, stretches well and is attached to the tongue in its middle part.
An abnormal structure may be the location of the frenulum closer to the edge of the tongue or even at its tip. In addition, a significant decrease in its elasticity, that is, its ability to stretch, is possible.
So in fact, the concept of “short bridle” is not entirely correct. Therefore, there is no clear solution to this issue.
When plastic surgery of the frenulum of the tongue and lips is required - techniques for performing the procedure
There are three frenulums located in the oral cavity: under the upper and lower lips, under the tongue. All of them perform a number of important functions, including ensuring the correct reproduction of sounds and the proper functioning of the mucous membrane, the formation of a bite and the maintenance of facial muscles. But there are often cases when it is necessary to trim the frenulum of the tongue or lips if it is too short and disrupts the functioning of the jaw apparatus. This is a simple procedure that is most often performed in early childhood, but is also relevant for adults who, for some reason, did not have it done in childhood. Read more about what this anomaly is, what it is called and how the operation is performed, further in this article.
What is the problem with the incorrect structure of the frenulum of the tongue?
In infants, an abnormal frenulum structure can cause difficulty sucking. In this case, the problem is solved in the maternity hospital by pruning. If the baby is still able to eat normally, doctors try to leave the situation alone, giving, as they say, time to grow. Indeed, in many cases, along with the growth of the jaw, the frenulum gradually stretches and takes on a normal shape.
In older children, a short hyoid frenulum creates some speech therapy difficulties:
- Difficulties arise with the pronunciation of hissing sounds.
- Correct reproduction of sonorants is not possible.
To pronounce the so-called upper lingual sounds, you need to raise the tip of your tongue upward. An insufficiently elastic bridle prevents this from being done.
However, it is very important to understand that it is not “responsible” for all speech problems. So if a child has a delay in speech development, syllables and sounds are “confused” in speech, a limited vocabulary or other problems, a short frenulum has nothing to do with it. The speech therapist will suggest effective methods of correction.
Why does the frenulum form incorrectly?
The frenulum under the tongue is a small elastic ligament that connects the organ to the floor of the mouth. Similar ligaments are present under the upper and lower lips in the middle. A shortened hyoid frenulum is an anomaly called ankyloglossia. In fact, this problem is widespread and the main cause is considered to be heredity. It is worth noting that this defect occurs much more often in boys than in girls.
On a note! If a child is prescribed frenuloplasty, this does not mean that one of the parents necessarily had a similar problem. Perhaps one of your close relatives has encountered a similar problem. That is, we are talking more about genetic predisposition.
Another common prerequisite for incorrect formation of the frenulum of the tongue and lips is maternal health problems during pregnancy. In this matter, it is difficult to identify specific factors that are guaranteed to lead to the development of a defect. But a similar problem occurs everywhere today, and most often children undergo correction immediately after birth, in the maternity hospital.
Some diseases suffered in the womb can cause the problem
How to check if a child has a short frenulum
The presence of difficulties with the frenulum can be easily determined independently:
- Open your mouth slightly and place the tip of your tongue in the area behind your upper teeth. In this position, the place of attachment of the frenulum is clearly visible. If it is not “where it needs to be,” it is difficult to lift the tongue up.
- Pull your tongue forward. A short frenulum does not allow this to be done; in addition, the tip of the tongue visually looks forked
- Open your mouth and try to touch your upper lip with your tongue and lick it. Difficulties with the bridle make this movement difficult to perform.
Please note: sometimes a child cannot cope with these exercises not because there is something wrong with the frenulum. The cause may be weak muscles of the articulatory apparatus. Take a clean handkerchief and try to help your tongue. If resistance is felt when moving, then the problem is still in the hyoid frenulum.
Methods of lip frenuloplasty
Today, the following methods are used to correct the frenulum of the lower lip:
- Frenotomy (dissection of the frenulum). This technique is used when the frenulum is too narrow and is not attached to the edge of the alveolar ridge. The dissection occurs across the fold.
- Frenectomy (excision of the frenulum). The technique allows you to correct too large a frenulum width. The incision is made along the ridge.
- Frenuloplasty (displacement of the area of attachment of the frenulum).
When using the above methods, sutures are applied with special absorbable threads. The procedure lasts about 15 minutes under local anesthesia and does not cause discomfort.
Laser plastic surgery of the frenulum of the lower lip
Correction of the shape of the frenulum has recently been increasingly performed using a laser. The cost of laser therapy is higher than the price of plastic surgery with surgical instruments, but the procedure is easier to tolerate. The laser beam excises unnecessary tissue, sealing the edges of the wound. The advantage of laser technology for frenulum correction is that there is no need for sutures. The surgical intervention is not accompanied by bleeding, and the recovery period takes a short period of time.
Thus, we can highlight the following advantages of laser plastic surgery of the lower lip frenulum:
- Painless.
- No blood.
- Eliminating the risk of infection (the laser has an antiseptic effect).
- Reduced level of psychological discomfort.
- Fast recovery.
- No need for stitches.
Due to its safety and painlessness, laser plastic surgery is used in children. But adult patients often choose this particular correction technique.
Post-operative care
Complete tissue healing after the procedure occurs in one to two weeks. During this time, the following recommendations should be followed:
- Perform regular, thorough oral hygiene with products prescribed by a specialist.
- Avoid eating hot, hard and sour foods.
- Visit your doctor for a follow-up examination at the time prescribed by the specialist.
- Perform gymnastics to strengthen muscles.
If you follow the above recommendations, the recovery period will pass quickly and without complications.
Who to contact for help
Depending on the complexity of the situation, an orthodontist or speech therapist will help you cope with the problem. In any case, it makes sense to first get a consultation to decide what method of correction the child needs.
The dentist will carefully trim the frenulum, relieving the child of discomfort with one movement of his hand. However, recently doctors still recommend leaving surgical intervention as a last resort. An experienced speech therapist will offer a set of exercises and massage to stretch the frenulum.
Experts say that there are not many situations when the hyoid frenulum is absolutely unable to stretch. In almost all cases, a conservative approach achieves results.
Parents can evaluate the pros and cons of different approaches on their own.
Surgical method:
- A quick, radical solution to the problem.
- The operation is performed using anesthesia.
- The healing process takes some time and is uncomfortable.
- Dietary restrictions due to surgery.
- It is advisable to maintain vocal rest for several days.
- Psychological trauma in the child is possible.
- After the operation, classes with a speech therapist are necessary to correct sound pronunciation.
Frenum stretching method:
- Conservative, does not cause psychological difficulties in the child.
- Effective in most cases.
- Does not require changes to your usual routine.
- It takes some time (several months).
- Requires discipline and regular practice.
In any case, to resolve the issue, you need to consult a speech therapist.
Methods for correcting ankyloglossia
The procedure can be performed on patients of different age groups. However, the technology for carrying it out may differ in each individual case. Next, we will consider options for eliminating ankyloglossia, depending on the age of the patient.
Plastic surgery of the frenulum in infancy
Today, a similar operation is performed on newborns in the maternity hospital or a little later in the dental clinic. This is a simple procedure that takes very little time and is called frenulotomy1. In a small child, the frenulum is still a very thin membrane with a minimal number of nerve endings. Using special scissors, the doctor makes a small transverse incision. Sometimes the wound is treated with a local anesthetic, but in other cases even this is not required.
“When my son was 4 months old, the doctor did not find any deviations from the norm. And then, when he was already a year old, at the next appointment it turned out that the frenulum needed to be trimmed. To be honest, this scared me a little, although the doctor explained that the operation was very simple and painless. Then I had never heard of lasers, and no one told me about them. The doctor cut with an ordinary scalpel, just a couple of seconds and that’s all...”
Olga33, Novorossiysk, from correspondence on the woman.ru forum
Under 5 years of age
At one year and up to 5 years, the operation is practically no different - similar plastic surgery is performed, but in this case the mandatory use of anesthesia is required. For children of this age group, the procedure may be painful, and to avoid discomfort, local anesthetics are used.
Children under 5 years of age require mandatory anesthesia during the procedure.
Teenage children
If the problem is not corrected immediately or before the age of 5 years, then later you will have to use another surgical method - frenuloplasty. This is a more serious procedure, which necessarily requires preliminary administration of anesthesia and subsequent suturing - special absorbable threads are used.
There are 3 different options for carrying out such an operation, and the choice of a specific technique directly depends on the degree of complexity of the problem:
- removal - the doctor makes triangle-shaped incisions at the top and bottom, while simultaneously clamping the frenulum with a special tool. Removal is performed and the wound is sutured,
- moving - the doctor makes two cuts, which will allow the jumper to be given the correct position. Then he slightly sutures the distance between the edges of the wound and fixes the selected fragment there,
- cutting - a specialist cuts the fold and then tightens its edges with sutures.
The choice of frenulum correction technique will have to be left to the discretion of the specialist. In general, the operation is quite simple and quick, and the use of anesthesia makes it completely painless.
The photo shows the labial frenulum before and after surgery
