Is lip frenuloplasty worth it?

The labial frenulum is a fold of mucous membrane (between the central incisors of the upper and lower teeth) that connects the lip and gum. It is involved in lip movement and articulation in speech. The health of the teeth, the correctness of the bite, the pronunciation of sounds, and the beauty of the smile depend on the quality and elasticity of the place where it is fixed to the gum.

The frenulum of the lip meets the gingival tissue at a distance of 5-8 mm from the necks of the anterior teeth. If it starts very close to the teeth, then it is considered to be shortened. It may also be that the frenulum is too wide. To avoid unpleasant consequences in the future or eliminate existing problems, doctors often recommend plastic surgery of the labial frenulum.

What is dangerous about the pathology of the frenulum attachment?

Indications for frenuloplasty arise not because of doctors’ desire to correct an anatomical feature, but for compelling reasons that affect the health and beauty of the smile. A similar defect results in:

to the formation of a diastema - an excess gap (gap) between the front incisors, which, moreover, tends to expand. A short frenulum is fixed too close to the edge of the alveolar process and pushes the teeth in different directions;
the appearance of a gum pocket - a depression behind the gum due to its injury by the frenulum, where food debris begins to accumulate, tartar forms, and the exposed necks of the teeth suffer from increased sensitivity. Ultimately, this process can lead to periodontitis, loosening and loss of teeth;
speech problems - with a short frenulum it is difficult to pronounce many consonants and some vowels (“o”, “u”);
bite pathologies - due to improper closure, tooth enamel is erased, teeth grow in the wrong direction, oral hygiene, the quality of chewing food and the functioning of the entire gastrointestinal tract deteriorate, and at the same time, a short frenulum prevents the correct installation of the braces system;
difficulties when performing prosthetics - a short frenulum does not allow the prosthesis to be firmly held in the mouth, and it may fall out while eating or talking;
injury during individual oral hygiene and its deterioration in general.

Upper lip frenuloplasty

Plastic surgery of the frenulum of the upper lip is a surgical intervention to trim the frenulum, performed on the patient if there are appropriate indications in the direction of an orthodontist or speech therapist. The frenulum of the lip is a special fold of the oral mucosa, which is responsible for additional attachment of the upper lip to the jaw bones.

In its normal position, the frenulum is woven into the gum at approximately a distance of 0.5-0.8 cm from the necks of the anterior incisors. With a lower attachment or when the frenulum of the lip extends beyond the front incisors and the attachment point is not visible at all, it is considered short. In such cases, it begins in the middle part of the upper lip and is attached approximately 0.4-0.6 cm above the gum, in the area of the gap between the front incisors (diastema).

A short frenulum is easily detected by visual inspection. To do this, you just need to retract the upper lip and examine the place where the mucous cord is woven.

When the frenulum is in a normal position, it does not have a negative effect on health and does not interfere with speech. A shortened frenulum can cause the development of a number of disorders. To correct it, an operation to plasticize the frenulum of the upper lip is performed.

Need for surgery

Most parents have a rather vague idea of the functions of the frenulum of the upper lip and its role in the normal functioning of the dental system. Therefore, when a specialist talks about the need for plastic surgery, many do not understand the importance of it. In reality, the problem must be resolved in a timely manner to avoid unpleasant medical and aesthetic consequences. It is the presence of the frenulum that allows you to correctly articulate, move your lips, open and close your mouth. With its defects (too short frenulum, its improper fastening), the mobility of the lips is significantly reduced, their functioning is disrupted, and various aesthetic defects develop.

The presence of such an anomaly leads to a number of consequences:

Limited sucking function in newborns. Since in infants the upper lip, together with the tongue, takes an active part in sucking, impaired mobility becomes an obstacle to the process of breastfeeding. In some cases, a neonatologist can independently trim the frenulum of the upper lip.
Impaired speech formation and correct sound pronunciation. With a shortened frenulum of the upper lip, as a rule, difficulties arise when pronouncing labial sounds, vowels (“o”, “u”, etc.). In this case, the speech therapist recommends plastic surgery, after which the diction is automatically corrected.
At an older age, due to frenulum defects, bite and chewing functions may be impaired, resulting in digestive problems.
The shortened frenulum of the lip, as well as its close attachment to the edge of the alveolar process, causes retraction of the interdental papillae of the gums in the space between the incisors. As a result, a gap is formed in the bone tissue between the sockets of the teeth - a diastema. In addition, the distance between the crowns increases.
A short frenulum pulls back the gums and leads to the formation of a gum pocket, the deposition of tartar and the development of an inflammatory process in the gums.
The consequences of defects in the frenulum of the upper lip can be instability of the teeth, exposure of their roots, and increased sensitivity. Plastic surgery allows you to avoid the development of a number of dental diseases.
A frenulum that is too wide leads to regular accumulation of food debris and the formation of plaque.
Surgery to correct the frenulum of the upper lip is necessary for the prevention of periodontal diseases and inflammatory processes in the oral cavity.

Indications

Medical intervention of any type must certainly be justified. A simple statement of the fact of the presence of a shortened frenulum is not an indication for emergency surgery. Plastic surgery to correct the frenulum is performed in the following cases:

If there is a diastema (gap) between the central incisors. The frenulum of the upper lip, woven into the interdental papilla and forming a thick cord, prevents the incisors from converging towards the center. In addition, exposure to a small constant load leads to a gradual increase in the diastema and displacement of the teeth forward and to the sides from the center, as well as the development of periodontitis due to constant injury to the interdental papilla.
In preparation for orthodontic therapy. Soft tissue cords located in the oral cavity, including the frenulum of the upper lip, exert a certain load on the dentition and influence the formation of the bite. If bite correction procedures are prescribed (installation of plates or braces), you also need to pay attention to the correct attachment of the upper lip frenulum.
If you have periodontal diseases and are at increased risk of their occurrence. In these cases, the short frenulum seems to “pull” the mucous membrane from the base of the teeth, which leads to gum recession - raising its edge and exposing the roots of the teeth.
In preparation for removable prosthetics. If the installation of dentures is planned, then it is first necessary to perform plastic surgery of the frenulum of the upper lip, since a shortened frenulum will provoke the shedding of the dentures.
In case of impaired sound production and other speech therapy problems (as a rule, this indication is less common than others).

Optimal time for the procedure

Although plastic surgery of the upper lip frenulum is a minor operation and does not lead to any consequences, it is performed extremely rarely on infants - only when there is a significant disruption of the breastfeeding process

The optimal age is over 5 years. This is a period of active change of bite, loss of milk teeth and eruption of permanent teeth, when the central teeth have erupted by at least 1/3, and the lateral ones have not yet appeared. Carrying out plastic surgery at this stage will help avoid the formation of a gap and will help the central incisors move towards the center (the erupting lateral incisors will also help with this).

Some experts recommend correction of the upper lip frenulum at 7-8 years of age, when the four upper incisors have already fully erupted. If indicated, the operation is also performed in adolescence and older age.

Contraindications

Surgery to correct the frenulum is not performed in the presence of the following conditions and diseases:

recurrent diseases of the oral mucosa;
Smile before and after frenuloplasty
osteomyelitis;
multiple caries with complications;
radiation irradiation of the head and neck area.

Of the general contraindications, it should be noted:

cerebral lesions;
dysmorphophobia;
alcohol abuse;
mental illness;
blood diseases (leukemia, hemophilia);
infectious diseases in the acute stage;
chronic diseases;
oncological diseases;
collagenosis, tendency to form keloid scars.

Preparing for surgery

No special preparation is required for the procedure. The oral cavity should be sanitized, since the presence of a source of infection can lead to the development of complications. Some specialists prescribe tests and fluorography, but there is no particular need for them: plastic surgery of the frenulum of the upper lip is a low-traumatic operation.

The only recommendation is to pre-feed the child, since in a hungry state it is more difficult for him to tolerate the procedure. In addition, hunger can affect blood clotting.

Types of operations and their essence

One of the main conditions for a successful operation: the baby must sit in a chair in a calm state for at least 15 minutes. Plastic surgery is performed using various methods. The choice of a specific method depends on the structure and attachment of the frenulum of the upper lip.

Frenotomy, or dissection of the frenulum. Its implementation is indicated in cases where the frenulum of the upper lip is too narrow, has the appearance of a transparent film and does not have points of attachment to the edge of the alveolar process. The dissection is carried out in the transverse direction, and suturing is carried out in the longitudinal direction.
Frenectomy, or excision of the frenulum. Prescribed for wide frenulum of the upper lip. The incision is made along the crest of the tense frenulum, and the interdental papilla and tissues located in the bone space between the root parts of the spread central incisors are excised.
Frenuloplasty – its essence is to move the attachment site of the frenulum of the upper lip. Currently, two types of frenuloplasty are performed.

Y-shaped frenuloplasty

After local anesthesia, the fixed frenulum is excised with a scalpel or special gum scissors. As a result of excision, a diamond-shaped defect remains on the mucosa. In order to mobilize the edge of the mucosa adjacent to the incision, it is trimmed and, using a thin rasp, moved along the periosteum in the apical direction (deep into the formed vestibule). Inside the vestibule, the mobilized mucous membrane is fixed with an interrupted suture to the periosteum. The wound is sutured tightly.

Z-shaped frenuloplasty (according to Limberg)

Infiltration anesthesia is performed, after which a vertical incision is made in the middle of the frenulum. Two oblique cuts are made in opposite directions from it at an angle of 60 to 85 degrees. The formed triangular flaps are mobilized and then fixed so that the central incision is located horizontally. It is very important to properly prepare the receiving bed: if the edges of the incisions are simply sutured together within the mucosa, you can only achieve a weakening of the tension, but it will not be possible to completely eliminate it. Ignoring this point leads to a significant decrease in the effectiveness of the procedure and, as a consequence, the not very popular popularity of this technique. The receiving bed is prepared in the same way as for Y-shaped frenuloplasty of the frenulum of the upper lip. The submucosal tissues are peeled off along the periosteum using a rasp, after which interrupted catgut sutures are applied to close the horizontal incision, while the flaps are fixed to the periosteum.

All of the above operations for plastic surgery of the upper lip frenulum are performed on an outpatient basis, under local infiltration anesthesia. For pain relief, Ultracan D-S forte containing epinephrine (1:100000 in 1.7 ml) is used.

Absorbable suture material is used to close the wounds, so they do not need to be removed later. The entire procedure takes approximately 15 minutes. According to reviews, it is completely painless and does not even cause discomfort.

Laser plastic surgery

Lately, plastic surgery of the upper lip frenulum using a laser has become very popular. The whole procedure takes only a few minutes.

Local anesthesia is first performed using a special gel, after which the light guide of a laser device is directed to the frenulum, forming a focused beam of light. Under its action, the frenulum “dissolves”. The laser also sterilizes and seals the edges of wounds.

Advantages of the method:

absence of vibrations and unnecessary sounds that frighten children;
bloodlessness;
no need for stitches;
eliminating the possibility of infection from surgical instruments by sealing the edges of wounds with a laser;
reducing the time of surgery for plastic surgery of the upper lip frenulum;
absence of pain and postoperative scars;
short rehabilitation period.

Postoperative care

As a rule, the period after plastic surgery of the upper lip frenulum is quite calm. Minor pain may occur after the anesthetic wears off. Rules to follow at this time:

Perform thorough oral hygiene daily.
Avoid hot and solid foods for 2 days.
Go through a post-operative examination (on the second or third day).

For older patients, special myogymnastics is recommended - exercises to strengthen facial and chewing muscles.

Over a certain period of time after frenuloplasty, one becomes accustomed to the freer movements of the tongue. Diction changes almost immediately after the correction. To eliminate the gap between the teeth (if it has already formed) it takes a little longer, and in some cases additional dental treatment is necessary.

The rehabilitation period lasts no more than 4-5 days. During this time, all unpleasant sensations disappear, and the wounds are completely healed.

Are there any contraindications?

When deciding whether to undergo lip frenuloplasty, the doctor will definitely assess the risks and check for contraindications. There are few of them, since the operation is considered minimally invasive:

recurrent pathologies of the oral mucosa;
tendency to develop keloid scars;
bleeding disorders;
inflammatory diseases of the jaws;
decompensated forms of chronic systemic diseases;
general disorders - mental disorders, cerebral pathologies, oncological processes, exacerbations of chronic diseases.

In what cases is it necessary to trim the bridle?

The operation of cutting the frenulum of the tongue is called frenulotomy . It is classified as simple and requires only local anesthesia.

Heavy bleeding during frenulotomy is very rare; after a couple of hours the child will be able to return to the usual rhythm of life.

If a short frenulum interferes with the newborn baby's ability to receive nutrition, it must be trimmed. The decision about surgery is made by a pediatric neonatologist.

For infants, as a rule, the operation is performed without anesthesia, since only the sublingual film of connective tissue is dissected, which has practically no blood vessels or nerve endings.

For children aged 3-5 years, surgery to cut the frenulum is performed under local anesthesia. The dentist decides whether surgery is necessary, and the speech therapist prescribes the referral.

Before the operation, the child needs to donate blood for a detailed analysis, which will display numerous indicators, including the number of platelets and the rate of blood clotting.

Surgical intervention is performed provided that the pathology is moderate or severe with limited tongue mobility. After surgery, speech therapy sessions are necessary.

There are a number of indications for frenulotomy, and limited tongue mobility is not the only one. The formation of malocclusion in a child, displacement and disturbances in the formation of the dentition, low effectiveness of speech therapy and articulation gymnastics, as well as the need to install dental implants or orthodontic structures for the child.

Pathology of the tongue frenulum does not always require surgical intervention. If the child does not experience any discomfort during breastfeeding, and his pronunciation of sounds is satisfactory, then it is likely that a speech therapist will help solve the problem. In this case, the child attends special classes, performs speech therapy exercises, articulation gymnastics, etc.

When to perform the operation?

It is best to perform the operation on children aged 5 to 8 years during the period when baby teeth are replaced by permanent teeth. The most appropriate moment is when the lateral incisors (“twos”) have not yet erupted, and the central ones have appeared by about a third. Plastic surgery will prevent the development of diastema and will help the incisors to take a central place.

The operation can be performed on both adolescents and adults. Plastic surgery of the frenulum of the upper lip in infants is performed only according to strict indications that affect the quality of the child’s nutrition.

In adulthood, surgery most likely will not solve the problem, but it will greatly facilitate the process of prosthetics.

Reasons for the development of tongue frenulum pathology in a child

The formation of an anomaly associated with a short hyoid membrane begins before the birth of the child. This is preceded by negative factors, which include:

genetic predisposition;
infection of the fetus during pregnancy;
viral and infectious diseases suffered by the mother during pregnancy;
mechanical injuries to the expectant mother’s abdomen;
the age of the expectant mother is over 35 years;
unfavorable environmental conditions;
the influence of other factors of unknown etiology.

How is the operation performed?

During a frenuloplasty operation, depending on the type of its structure, the surgeon cuts the fold, excises excess tissue or moves the point of its attachment to the gum. The procedure is performed under local anesthesia, is absolutely painless and lasts no more than 10-15 minutes.

At the IONIKA clinic, doctors are equally proficient in both methods of frenuloplasty - laser and scalpel. Each technique has its own strict indications, its advantages and disadvantages. Despite the fact that laser plastic surgery of the upper lip frenulum has gained the greatest popularity today, we sensibly assess each clinical situation and choose the optimal way to solve the problem based on the patient’s characteristics.

Laser . This is a minimally invasive method in which a laser beam “dissolves” the frenulum or removes excess tissue, immediately sealing the edges of the wound. The operation is completely bloodless, without the need for stitches, and rehabilitation takes a minimum of time. Laser plastic surgery of the lower lip frenulum is most often used when working with young patients.
With a scalpel . The classical method is also low-traumatic and is supplemented only by suturing. It is used, as a rule, in cases with a thickened frenulum.

How to recognize pathology in a child

A neonatologist, pediatrician, or the mother herself can recognize a pathological frenulum of the tongue in a newborn. If during the first and subsequent breastfeedings the baby experiences difficulties and cannot grasp the nipple correctly, then there is a reason to consult a doctor.

The second common sign of a pathological frenulum of the tongue in children is the occurrence of a speech defect when they begin to speak in phrases, namely at 3-4 years. Most often, with this anomaly, children do not pronounce several letters: “zh”, “sh”, “sch”, “ch”, “z”, “l” and “r”. Moreover, the sound “l” is easily pronounced if it is followed by a soft vowel, for example, “i”, “yu”, “e”, “e”, “ya”, in other cases it is simply “swallowed”. If there is incorrect pronunciation of sounds, then an examination by a speech therapist is necessary.

The most common symptoms of a tongue tie in a child are the following:

the child is not able to reach the front teeth of the upper jaw or palate with the tip of his tongue;
the child may have difficulty moving the tip of the tongue from one side to the other;
the front teeth of the lower jaw may have a gap between each other;
when the tongue is pulled forward, its tip remains flat, square or heart-shaped (that is, the front edge of the tongue seems to bifurcate);
feeding problems in newborns.

It is important to understand that if the problem of the tongue frenulum exists, then sooner or later it will have to be solved. The sooner measures are taken, the easier and more painlessly the baby will endure them.

How long will it take to heal?

After plastic surgery of the frenulum of the lower lip, the rehabilitation period takes up to two weeks, and the wound on the upper lip heals in just a few days. In the first case, anti-inflammatory treatment is often prescribed to ease the postoperative period and eliminate the risks of complications.

To avoid injury and the risk of infection, thorough but gentle oral hygiene twice a day is necessary. You should avoid hard and hot foods in your diet, and rinse your mouth after eating. Parents are advised to pay closer attention to the cleanliness of their child’s hands.

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Exercises for correcting the frenulum of the tongue and in the postoperative period

Postoperative frenulum stretching and correction exercises are aimed at developing new muscle movements of the tip of the tongue inside and outside the mouth. Regular practice will increase the range of movement of the tongue.

Articulation exercises by themselves will not improve speech and will not be able to correct the defect, so it is very important to carry them out in conjunction with individual speech therapy sessions.

The most common and universal exercises for stretching and correcting the frenulum of the tongue are given here in the article. Following them, you can study at home with your child on your own:

Stretch your tongue forward, then stretch the tip up to your nose, then down to your chin. Relax, repeat the exercise several times (at first, up to five repetitions are enough, gradually the number of repetitions must be increased, bringing them to twenty).
The exercise is performed by analogy with the previous one, moving the tongue left and right. The number of repetitions is also gradually increased to twenty.
Open your mouth wide. Use the tip of your tongue to touch the upper incisors and try to press on the teeth with all your might, not allowing your mouth to close. During each execution, mentally count to ten. The number of repetitions is the same as the previous ones.
The exercise is performed in front of a mirror. The mouth is wide open. When performing the exercise, it is important to monitor the movements of the tongue. Pronounce the syllables “dar-dar-dar”, “nar-nar-nar”, “tar-tar-tar”, etc.
Sticking your tongue forward as much as possible, alternately “lick” your upper and lower lips.
Closing your mouth, move your tongue from right to left and back, forcefully pressing the inside of your cheeks with the tip of your tongue.

To achieve good results, exercises should be performed daily, in several approaches, for 15-20 minutes . The articulation of specific sounds can be gradually corrected.

Important! You can begin to perform exercises for the frenulum of the tongue only after the wound has completely healed.

Speech therapy classes should include exercises to improve the functioning of the speech apparatus and oral kinesthesia, without which it is difficult to claim significant improvements in the development of a child’s speech. Many young patients, after cutting the frenulum, begin to speak more quietly and more quickly, trying to “drown out” speech problems.

Frenuloplasty

Frenuloplasty is a surgical method for treating the complete form of ankyloglossia. It is performed on children who are already 5 years old, since they are already able to understand the essence of the procedure, as well as on adult patients. There are 3 options for performing the operation:

Removal - during the operation, a significant part of the frenulum is clamped with instruments, incisions are made from below and above in the shape of a triangle, and the edges of the wound are sutured.
Cutting is the easiest method for this pathology. The fold is cut, and its side edges are pulled together using transverse seams, while grasping the fabric at great depth.
Moving the attachment point. In this case, 2 incisions are first made, which separate a strip of tissue between the interdental papillae and the transitional fold. The edges are brought together using suture material, and the cut strip is then sewn to the area of the wound that remains.

Exercise is a good alternative to surgery

If parents are willing to put in a lot of effort and spend a lot of time, then treatment for a short frenulum of the tongue can be carried out using gymnastics. Classes with the child should be regular, several times a day, and the number of approaches and repetitions should be gradually increased.

Basic exercises to stretch the frenulum:

tongue movements with half-opened lips along the upper lip;
protruding the tongue to its maximum length and returning it back;
licking a saucer (or imitating this action);
touch the tip of your nose with your tongue, then your chin and your nose again.

After treatment for a short frenulum, the patient visits a speech therapist and gets acquainted with special exercises that help stretch the muscles and folds of the tongue. In some cases, facial massage is performed. If angiloglossia is treated in a timely manner, there will be no consequences for the full development and health of the child.

Why frenulum abnormalities require seeing a doctor

Abnormalities of the labial frenulum

Such a frenulum (either short or long) leads to the fact that the front teeth move apart and a gap forms between them - a diastema. In addition, over time, gum recession occurs and tooth roots become exposed. This is dangerous because teeth become more sensitive and the risk of caries increases.

Anomalies of the frenulum of the tongue

feeding difficulties: immediately after birth, the baby experiences difficulties, he has to make Herculean efforts to suck breast milk or a bottle of formula. Discomfort makes the baby refuse to eat, the baby becomes very capricious, and loses weight. This is due to the fact that the sucking reflex is impaired, since the tongue is limited in movement,
Digestive problems: difficulty eating and swallowing leads to diseases of the gastrointestinal tract,
developmental delay: such a child takes longer to gain weight than healthy ones and grows worse. Not receiving the vitamins and substances the body needs, it begins to lag behind its peers,
articulation disorder: the voice becomes hissing or whistling, a lisp appears. The change in diction is explained by the fact that the child cannot pronounce certain sounds normally - again due to limited tongue movement,
the development and proper functioning of the entire maxillofacial apparatus is disrupted.

Most often, a violation of the structure of the frenulum is a congenital pathology; there is also a high probability of the pathology being transmitted by inheritance - studies note1 that parents who suffered from this disease in childhood had beloved children who were also susceptible to a similar anomaly. But in some cases, the reason lies in the occurrence of problems during pregnancy: these could be frequent stressful situations, a lack of vitamins, or untreated infections in the baby’s mother.