Frenulum trimming surgery in children and adults: how it happens, exercises after the procedure

Frenulum excision is a surgical operation performed on the frenulum to correct its developmental anomalies. Intervention in this area can be one of three operations. The first is a classic transverse dissection of the frenulum to lengthen it - frenulotomy ("fren" - frenulum, "tomy" - cutting). The second option is frenulectomy, which is a wedge-shaped excision of the frenulum of the tongue. And the third type of intervention is frenuloplasty - a change in the shape, size, location of the frenulum by plastic surgery of local tissues. It is worth noting that terms with the root "fren" are applied not only to operations on the mucous strand of the tongue. Correction of any frenulum (upper lip, penis, etc.) can be called frenulotomy, frenuloplasty, etc. Therefore, this concept always requires clarification. Since this article only deals with the frenulum of the tongue, the terms will be used without interpretation.

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Indications for the procedure

Indications for operations on the frenulum of the tongue are some anomalies of its development. The mucous cord may be short or attached too close to the tip of the tongue. Clinically, this is manifested by various functional disorders depending on the age of the person. In infancy, the child cannot suckle, feeding lasts for a very long time or does not start at all. The baby simply refuses the breast, begins to cry and does not fall asleep for a long time. As a result, there is no increase in body weight, the child's growth slows down. Although, when examining other organs and systems, pathologies are usually not determined. In any case, before the operation, the child must be examined by a pediatrician.

In the period from 2 to 5 years, with a shortened frenulum of the tongue (ankyloglossia), various speech defects begin to form. The pronunciation of the sounds "r" and "l" is impaired, speech becomes slurred and difficult to perceive. But if the speech defect was detected earlier than the shortened frenulum of the tongue, then it is worth checking all possible causes of speech dysfunction. After all, this is not always associated with the lingual frenulum. Sometimes speech defects are provoked by malocclusion, disorders of the central nervous system and temporomandibular joint. Therefore, the child should be examined by a dentist, speech therapist and pediatrician. And if the problem is only in the shortened frenulum of the tongue, then a set of massage procedures is prescribed. If myogymnastics did not give positive results, then one of two types of frenuloplasty is performed.

In adolescence, when the facial bones should be actively developing, a short frenulum of the tongue can restrain the growth of the lower jaw. It is hard to believe unless you see the consequences of a shortened frenulum with your own eyes. People tend to perceive bone tissue as the most powerful and strong in the body. According to this logic, it is the bone structures that should control muscle growth, and not vice versa. However, in nature, everything is different, muscle and connective tissues have amazing strength capabilities. And if they are formed incorrectly, this entails violations of the development of bone formations. With a short frenulum of the tongue, the lower jaw begins to lag behind in development and visually looks shortened. If you look at a person in profile, you will notice that the upper jaw is “longer” and the lower is shorter. When smiling, you can see that the upper incisors are in a more forward position than the lower ones (by 0.5 cm or more). This type of bite aggravates existing disorders and provokes the appearance of others. Due to the fact that the incisors do not contact each other, the chewing load is distributed to other teeth. This contributes to the overload of the chewing teeth and is a risk factor for the development of periodontitis. Also, on the lower jaw, most likely, there will not be enough space for all the teeth. As a result, some of them will be tilted towards the oral cavity or towards the lips, and some will be rotated around their axis. In general, the dentition will be narrowed and shortened. To determine the cause and assess the severity of these disorders, an orthodontist consultation will be required. Also, with a shortened lower jaw, there will be posture and gait disorders. And of course, an important factor is the decrease in aesthetic indicators with a reduced lower jaw. But all this can be prevented if you timely identify developmental disorders of the frenulum of the tongue and carry out its high-quality correction.

In adults, a shortened frenulum does not have such a significant effect on the functioning of the body as in children. This is due to the fact that all structures have long been formed and adapted to the given conditions. And even if there are speech defects caused by a short frenulum, it is unlikely that they can be corrected by frenuloplasty alone. In this case, the comprehensive participation of a dentist, speech therapist-defectologist and gnathologist will be required. However, frenuloplasty is guaranteed to bring some positive results. In adulthood, trimming the short frenulum of the tongue minimizes the aggravation of periodontitis in the frontal area. Also, due to the reduction in tissue mobility under the tongue, there will be no problems with fixing the prosthesis during prosthetics.

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Preparation

No special preparation is required for surgery on an infant. At this age, the frenulum has an avascular structure and does not contain nerve endings. Therefore, the surgery will be bloodless, painless and will last only a few seconds. It is worth paying attention to the emotional state of the child. After all, the most common reason for canceling an operation is the incessant crying of an infant. In this case, it will be impossible to perform even the simplest operation. Therefore, before the operation, the child should be well-fed, calm and a little sleepy. Even if he is sleeping, this will only be a positive moment. In such a situation, the surgeon will be able to perform the operation as unnoticed as possible for the baby.

If the shortened frenulum of the child has not been lengthened naturally and surgically by the end of the infancy period, then after 1 year of life it will already contain a certain number of vessels and nerve endings. Considering the fact that the frenulum of the tongue will begin to actively grow, be supplied with blood and innervated, frenulotomy will no longer be indicated. Most likely, the surgeon will offer one of the frenuloplasty options. In this case, the surgical intervention will be performed under general anesthesia. This is due to the fact that the frenuloplasty operation is more radical than a regular frenulotomy. In addition to this, the mucous cord has nerve endings and vessels, which provokes pain and bleeding. Undoubtedly, anesthesia is not a useful procedure for the child's body. However, it allows you to perform the operation, adhering to the protocol. The anesthesiologist will select an anesthetic and calculate the exact dosage, which will be optimal for this person. Junior medical staff will assist the surgeon and monitor the general condition of the child. And the doctor will perform all the necessary manipulations aimed at lengthening the frenulum under the tongue.

In childhood, adolescence and adulthood, frenuloplasty can be performed using infiltration anesthesia. If we are talking about a child aged 6-10, then special psychological preparation will be required before the operation. The child should not only be prepared to be patient during a surgical appointment, but also be able to bear the pain that will occur during anesthesia. There are often cases when a child is given an injection of painkiller, and after it, the little patient refuses further manipulations by the doctor. Therefore, you should not deceive the child and say phrases such as “the doctor will not do anything”, “it does not hurt at all”, “we will just have a look”. If you lie to your child, the next dental appointment may not take place in the coming years. It is necessary to distract the child from medical manipulations as much as possible. His vision should be focused not on the surgeon holding a syringe in his hands, but on cartoons on TV, birds outside the window, toys, etc. He should not hear comments from junior medical staff about the amount of anesthetic and the choice of scalpel, but riddles, questions, stories adapted for children's perception. A dental assistant can do this. It is also important to maintain tactile contact with the child. Constantly touching his hands and shoulders can distract the child from the surgeon's manipulations in the oral cavity.

The above rules should not be neglected, as surgical interventions often cause stress even in adults. And a child, who tends to exaggerate and fantasize, perceives dental manipulations even more dangerously.

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Technique frenulum trimming

Cutting the frenulum of the tongue of a newborn is performed without any medication preparation or anesthesia. The doctor makes a transverse incision on the frenulum with surgical scissors - and this is the end of the operation. It is worth saying that these manipulations are absolutely painless for the child. This is due to the fact that the thin mucous cord has virtually no nerve endings, which eliminates pain sensitivity. The only thing that needs to be done is to deliver the child to the surgical room in comfortable conditions for him. If the baby is emotionally stable, then neither you nor the surgeon will have any difficulties. No postoperative procedures should be performed. There is no damage to blood vessels and nerves, there is no wound, infection is excluded. A child of this age does not eat too cold, hot and spicy a priori. Therefore, such recommendations will also be inappropriate.

When frenulotomy is no longer indicated due to age, frenuloplasty is performed, which can be done using two main techniques. The first technique (Y-shaped frenuloplasty): the frenulum is cut transversely with surgical scissors. The mucous membrane above the cut is pierced with a needle with suture material (catgut). Holding the tongue by the threads, it is lifted up and pulled forward. After this, the wound is lengthened longitudinally with scissors and the underlying soft tissues are cut. A diamond-shaped wound is formed. The operation is completed by suturing. The second type of surgical intervention is called Z-shaped frenuloplasty. It consists of making a Z-shaped incision instead of a longitudinal one. This way, two triangular flaps can be obtained. By turning them by 60°, the incision can be turned into a horizontal one. After this, the wound is sutured.

Frenulectomy can be performed by wedge excision of the frenulum of the tongue and suturing the wound. However, most often this type of surgery is performed using a laser unit. The use of such equipment is explained by numerous advantages. The first is the minimum amount of anesthetic. When cutting the frenulum of the tongue with a laser, a large amount of anesthetic does not need to be used, ¼ of the dose is enough. This allows you to preserve the original shape and mobility of soft tissues, which will ensure the accuracy of the operation. The second advantage is ease of use. It is due to the fact that the force of the laser on soft tissues is always the same and is determined by the settings of the unit. And the depth of the cut with cutting instruments always depends on the applied force of the surgeon. Therefore, when working with a laser, a specialist has the opportunity to focus only on the direction of the laser flow. And the doctor does not have to worry about sudden damage to the underlying tissues. The third advantage is safety. When working with surgical scissors or a scalpel, the instruments are always in the patient's mouth. And any movement of the patient can cause serious injury to the soft tissues of the oral cavity. And if we consider that most children are prone to fear of surgical interventions, then any unexpected fright can entail sharp movements of the child's head. However, the operation of the laser unit is completely controlled by the doctor using a foot pedal. If the child is frightened and suddenly begins to move, the doctor will immediately react, release the pedal and the laser will stop working. The fourth advantage of laser frenectomy is the absence of the need for suturing. Suturing is a long and responsible manipulation. When performing it, it is important to choose the right thickness and material for the surgical thread. It is necessary to carefully suture the wound and leave no gaps, it is important to do it moderately. To perform all these tasks, you need time, experience and the patient's calm. Unfortunately, these factors do not always exist simultaneously. If we talk about laser frenectomy, it does not require suturing, and healing occurs faster than when performing a classic surgical operation. The fifth advantage is the positive attitude of children to laser dentistry. This factor plays a very important role when performing frenectomy on pediatric patients. When they learn that they will have their frenulum cut with a laser, most of them are looking forward to the operation with considerable interest. At the dentist, the child receives special protective glasses, which together with the laser installation look very futuristic. As a result, the operation is painless and comfortable for the little patient.

Contraindications to the procedure

There are no special contraindications to the operation of cutting the frenulum of the tongue. Any surgical operations are not performed if the patient has active inflammatory diseases. In case of pathologies of the endocrine and cardiovascular systems, the issue of individual drug preparation is considered. If it is possible, then the surgical intervention will also be performed. In some situations, the operation cannot be performed under local anesthesia. Mental illnesses, fear of doctors and medical interventions, allergies to local anesthetics can be present in people of any age. Therefore, if even a simple operation is extremely necessary, then it can be performed under anesthesia. As for the specific cutting of the frenulum of the tongue, it is not recommended to perform it before undergoing a course of myogymnastic procedures. After all, if the physical load of the frenulum contributes to its stretching, then surgical intervention will not be needed.

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Consequences after the procedure

Cutting the frenulum of the tongue has only positive effects if it is performed according to indications. Therefore, the consequences of the operation can be foreseen even before the start of the surgical intervention. If a child has a speech defect and has not undergone a course of myogymnastics beforehand, then the expediency of the operation remains questionable. After all, speech problems could have been corrected in a more conservative way. And in the case when the cause of incorrect pronunciation of sounds is a malfunction of the central nervous system, then even frenuloplasty will be ineffective. Moreover, it can aggravate the existing pathology.

With a correct diagnosis, high-quality surgery and monitoring of the postoperative period, frenulum trimming helps to normalize speech function. In combination with myogymnastics, correct pronunciation of sounds occurs quite quickly. If orthodontic treatment is carried out after the surgery, aimed at stimulating the growth of the lower jaw, it will also be very effective. In adults, after frenulum trimming, periodontitis treatment is more productive than before surgery. If the patient has undergone surgery for further prosthetics, then orthopedic treatment is also very likely to be successful.

Complications after the procedure

After frenulotomy, complications are usually not observed. This is due to the fact that the operation is quite simple to perform, bloodless and painless. After frenuloplasty, complications may be associated with the doctor's mistakes or the patient's failure to follow the rules for wound care. As for complications caused by the surgeon's actions, they may be associated with a violation of the technique of suturing the wound. If the doctor applies fewer stitches than necessary, the wound will not be isolated from the oral cavity. This will increase the risk of pathogenic microflora and the development of inflammation in the area of the frenulum of the tongue. If the stitches are unevenly stretched, some areas of the soft tissue will be compressed by the suture material, while others will become excessively mobile. This may cause the frenulum of the tongue to shift, which is an undesirable outcome of the operation. If the doctor's instructions are not followed, purulent-inflammatory processes sometimes occur at the site of the wound. In this case, after the frenulum is cut, the body temperature rises, headaches, drowsiness and other symptoms of intoxication occur. Often this is due to the fact that people cannot give up their usual regime, they continue to smoke, brush their teeth once a day and skip taking prescribed medications. This jeopardizes the entire result of the treatment and can lead to serious consequences. If you follow all the surgeon's recommendations, the postoperative period will go according to plan and complications will not arise.

If the frenulum of the tongue was cut under anesthesia, the person may experience a reaction to general anesthesia drugs for several days. In the first days after the operation, the tongue may hurt, drowsiness may be present, nausea may appear, vomiting may occur. These symptoms should gradually go away within 2-3 days.

After cutting the frenulum of the tongue with a laser, complications rarely occur and may manifest themselves in the form of a postoperative scar. This is due to a violation of the technique of the intervention or incorrect laser settings. In this case, a repeat operation may be necessary.

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Care after the procedure

After tongue tie surgery in newborns, no postoperative care is needed.

If frenuloplasty was performed on a child under general anesthesia, then the patient will recover from the anesthesia for several hours after the operation. This may manifest itself in emotional excitement, anxiety, or, conversely, drowsiness and inhibition. The child may also experience thirst, nausea, vomiting, headache, pain, and dizziness. Therefore, the child must be provided with rest for several days. Attention should be paid to thorough antiseptic treatment of the oral cavity. There should be no foreign substances in the area of the operation, plaque and food debris are not allowed on the teeth. This can provoke the addition of pathogenic microflora and cause suppuration of the wound. It is also necessary to refrain from eating hot and spicy food for several days. If the healing process goes smoothly, then 3-4 days after surgery, you can begin working with a speech therapist and conduct myogymnastics courses.

After frenuloplasty under infiltration anesthesia, which was performed on a child or young patient, care should be aimed at maintaining cleanliness in the oral cavity. For this, you can use various mild antiseptics (chlorhexidine bigluconate 0.06%, hydrogen peroxide 3%, etc.). If frenulum trimming was performed in adulthood before prosthetics or complex treatment of periodontitis, then postoperative care will be slightly different. Firstly, before such surgical interventions, middle-aged and mature people are most often prescribed a 5-day course of antibiotics. It begins 2 days before the operation and lasts 2 days after the operation. It is important not to finish the course of antibacterial drugs before the specified period. After all, this can disrupt the process of soft tissue regeneration and provoke inflammation. Also, at the time of the postoperative period, it is necessary to give up bad habits. Alcohol inhibits the effect of antibiotics, and smoking disrupts the processes of soft tissue restoration in the area of surgical intervention. If the patient has chronic diseases in the oral cavity, it is recommended to use antiseptics (infusions of chamomile, sage and other medicinal herbs), anti-inflammatory and antifungal drugs (Listerine, Givalex, Metrogyl Denta gel). After a 4-5 day recovery period, you can contact a doctor about correcting speech defects, orthodontic treatment, prosthetics, etc.

Laser frenectomy, except for prophylactic antiseptic procedures, does not require general and local use of drugs. You only need to be careful not to injure the sublingual area, and also not to eat hot and spicy food in the first days after the operation.

Myogymnastics

Myogymnastics is a very important treatment and preventive procedure. It allows not only to consolidate the result of surgical treatment, but also in some cases to avoid it.

If a child has a shortened frenulum of the tongue and speech defects begin to develop against its background, then first of all it is necessary to undergo a course of gymnastic exercises. They help to stretch the mucous strand of the tongue, which can ensure the normalization of speech function. Myogymnastics can be done at home and by a speech therapist. There is a whole set of effective exercises. The first is to touch the palate near the upper incisors with the tip of the tongue. Without lifting the tongue from the palate, open and close the mouth. The exercise must be done smoothly, without sudden movements. Ten repetitions will be enough. The second exercise is to push the tongue forward as much as possible. Move the tongue to the sides, alternately touching the right and left corners of the mouth (10 repetitions). The third exercise is to push the tongue forward as much as possible and then alternately move it up and down (10 repetitions). The fourth task is to push the tongue forward as far as possible and hold it in this position for 5-10 seconds. The fifth is to push the tongue forward a little and roll it into a tube. (5-10 repetitions). When performing the first four tasks, the tongue should be flat and relaxed. You should carefully monitor the technique of performing the exercises. The child must perform them correctly and efficiently. The main principles: smoothness, low speed, large amplitude of movements. The first training sessions should be supervised by parents from beginning to end. To do this, you can sit opposite the child and ask him to repeat the exercise after you. Another effective method is training in front of a mirror, which provides visualization of the articulatory gymnastics. At the speech therapist, the course of myogymnastic procedures will be supplemented with exercises to set the correct pronunciation of sounds. With an attentive and conscientious approach to this technique, in just a month the frenulum can stretch to the desired length. The child will learn to freely pronounce all sounds, and you will realize with a smile that surgical intervention will not be required.

If the frenulum of the tongue has been cut, this does not mean that all the disorders will disappear on their own. After the soft tissues in the area of the operation have been restored, a course of gymnastic procedures is required. The exercises and principles of their implementation are no different from those described in the previous paragraph. It should also be noted that it is important for a doctor to participate in tongue gymnastics after the frenulum has been cut. A specialist will be able not only to teach how to do the exercises correctly, but also to determine when it is worth ending the course of procedures or changing the treatment plan.

The operation of cutting the frenulum of the tongue shows good results at any age. If you contact a competent doctor, follow his appointments and recommendations, then this surgical intervention will be a successful investment in your health!

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