Operation of pruning of the frenum of the tongue in children and adults: how it happens, exercises after the procedure

Pruning a tongue is a surgical operation that is performed on a bridle in order to correct anomalies of its development. Intervention in this area can be one of three operations. The first is the classical transverse dissection of the frenum with the aim of elongation - frenulotomy ("fren" - frenum, "tomia" - cutting). The second option is frenuloectomy, which is a wedge-shaped excision of the frenum of the tongue. And the third type of intervention - frenuloplastika - changing the shape, size, location of the frenum by the plastic of local tissues. It should be noted that the terms with the root "fren" are applied not only to operations on the mucus of the tongue. Correction of any frenum (upper lip, penis, etc.) may have a name with frenulotomy, frenuloplasty, etc. Therefore, this concept always requires specification. Since this article deals only with the bridle of the tongue, in future the terms will be used without interpretation.

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Indications for the procedure

Indications for operations on the bridle of the tongue are some anomalies of its development. The mucosa can be short or attached too close to the tip of the tongue. Clinically, this manifests itself in various functional disorders, depending on the age of the person. In infancy, a child can not suckle the breast, feeding lasts a very long time or does not begin at all. The kid simply refuses the breast, begins to cry and does not fall asleep for a long time. As a result, the increase in body weight does not occur, the growth of the child slows down. Although, in the examination of other organs and systems, pathologies are usually not determined. In any case, the child must be examined by a pediatrician before the operation.

In the period from 2 to 5 years with a shortened bridle of the tongue (ankyloglossia) different speech defects begin to form. The pronunciation of the "p" and "l" sounds is disrupted, the speech becomes illegible and difficult to comprehend. But, if a speech defect was detected earlier than a shortened bridle of the tongue, then it is worthwhile to check all possible causes of speech function disruption. After all, this is not always associated with a lingual frenum. Sometimes speech defects are caused by an incorrect bite, disruption of the central nervous system and temporomandibular joint. Therefore, a dentist, a speech therapist and a pediatrician must examine the child. And if the problem is only in the shortened bridle of the tongue, then a set of massage procedures is appointed. In the event that myogymnia did not give positive results, then one of two types of frenuloplasty is performed.

In adolescence, when an active development of the bones of the facial skeleton should occur, a short frenum of the tongue can restrain the growth of the lower jaw. It's hard to believe, if you do not see the consequences of a shortened bridle with your own eyes. It is peculiar for a person to perceive bone tissue as the most powerful and strong in the body. According to this logic, bone structures should control muscle growth, and not vice versa. However, in nature everything is different, the muscular and connective tissues have amazing power abilities. And if they are formed incorrectly, then this entails a violation of the development of bone formations. With a short frenum of the tongue, the lower jaw begins to lag behind in development and visually looks shorter. If you look at the person in profile, it will be noticeable that the upper jaw is "longer" and the lower one is shorter. With a smile, you can see that the upper incisors are in a more forward position than the lower ones (by 0.5 cm or more). This form of bite aggravates existing disorders and provokes the appearance of others. Due to the fact that the incisors do not contact each other, the gum load is distributed to other teeth. This promotes 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 inclined 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 violations, an orthodontist consultation will be required. Also, with a shortened jaw, there will be disturbances in posture and gait. And of course, an important factor is the decrease in aesthetic indicators with a reduced lower jaw. But, all this can be prevented if in time to detect violations of the development of the frenulum of the tongue and qualitatively carry out its correction.

In adults, the shortened bridle does not have such a significant effect on the functioning of the body, as in children. This is due to the fact that all the structures have long been formed and adapted to the specified conditions. And even if there are speech defects, provoked by a short frenulum, then it will hardly be possible to correct them by carrying out only frenuloplasty. In this case, a comprehensive participation of a dentist, speech therapist and gnatologist will be required. However, some positive results frenulopoapoistika guaranteed to bring. In adulthood, pruning a short frenulum minimizes the worsening of periodontitis in the frontal area. Also, by reducing the mobility of tissues under the tongue, with prosthetics there will be no problems with fixing the prosthesis.

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Preparation

Special preparation for the operation of an infant is not required. At this age, the bridle has an avascular structure and does not contain nerve endings. Therefore, the operation 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 continuous crying of a baby. Even the simplest operation will not be possible. Therefore, before the operation the child should be full, calm and slightly drowsy. Even if he is asleep, it will only be a positive moment. In such a situation, the surgeon will be able to perform the operation as imperceptibly as possible for the baby.

If the shortened bridle in a child has not been lengthened naturally and surgically until the end of the nursing period, then after 1 year of life it will already contain a certain number of vessels and nerve endings. Given the fact that the bridle of the tongue will begin to actively grow, be blooded and innervated, the conduct of frenulotomy will not be shown. Most likely the surgeon will offer one of the options of frenuloplasty. In this case, surgery will be performed under general anesthesia. This is due to the fact that the operation of frenuloplasty is more radical than the usual frenulotomy. In addition to this, the mucous throat has nerve endings and vessels, which provokes pain and bleeding. Undoubtedly, anesthesia is not a useful procedure for a child's body. However, it allows you to perform the operation, adhering to the protocol. An anesthetist will choose an anesthetic and calculate the exact dosage, which will be optimal for this person. The 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 bridle under the tongue.

In childhood, adolescence and adulthood ,  fenuloplasty can be carried out using infiltration anesthesia. If it is a child of 6-10 years, then the operation will require special psychological preparation. A child should not only be ready for assiduous behavior at a surgical procedure. But also it will be obliged to transfer the pain that will arise when anesthesia is performed. Often there are cases when a child is given an injection with an anesthetic, and after it the small patient already refuses further manipulation of the doctor. Therefore, there is no need to deceive the child and say the phrase "the doctor will not do anything", "it does not hurt at all," "we'll just see." If you lie to the child, the next dental appointment may not take place in the coming years. It is necessary to maximally distract the child from medical manipulation. His vision should be focused not on the surgeon who holds a syringe in his hands, but on cartoons on TV, birds outside the window, toys, etc. He should not hear the comments of junior medical personnel about the amount of anesthetic and choice of a scalpel, but riddles, questions, stories adapted for the child's perception. This can be done by an assistant dentist. It is also important to maintain tactile contact with the child. Constantly touching his arms and shoulders, you can distract the child from manipulation of the surgeon in the oral cavity.

Neglect the above rules can not, because surgical interventions often cause stress, even in adults. A child who is prone to exaggerate and fantasize, perceives dental manipulation is even more dangerous.

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Technique of the pruning of the tongue

Cutting the frenum of the tongue to the newborn is done without any medical preparation and anesthesia. The doctor surgically scissors performs a transverse incision on the bridle - and this completes the operation. It is worth saying that for the child these manipulations are absolutely painless. This is due to the fact that the thin mucous band has almost no nerve endings, which excludes pain sensitivity. The only thing that needs to be done is to take the child to the surgical room in comfort conditions for him. If the baby is emotionally stable, then neither you nor the surgeon will have any difficulties. No post-operative procedures should be conducted. Vascular and nerve damage is not present, the wound is absent, infection is excluded. Too cold, hot and sharp the child at such an age does not use a priori. Therefore, such recommendations will also be inappropriate.

When frenulotomy by age indices is no longer indicated, frenuloplasty is performed, which can be carried out by two main techniques. The first technique (Y-like frenuloplasty): with surgical scissors dissect the bridle in the transverse direction. Mucous above the incision is threaded with a suture needle (catgut). Holding the tongue by the threads, it is lifted up and pulled forward. After that, scissors extend the wound in the longitudinal direction and dissect the underlying soft tissues. A wound of a rhomboid shape is formed. The operation is completed by the application of stitches. The second type of surgery is called Z-like frenuloplasty. It consists in the fact that the Z-shaped is performed instead of the longitudinal section. So you can get two triangular flaps. Rotating them by 60 °, the cut can be turned into a horizontal direction. After that, the wound is sutured.

Frenuloectomy can be carried out by wedge-shaped excision of the frenum of the tongue and wound suturing. However, most often this type of operation is performed using a laser installation. The use of such equipment is explained by numerous advantages. The first is the minimum amount of anesthetic. When pruning a tongue frenulum with a laser, a large amount of anesthetic is not needed, enough ¼ dose. This allows you to keep the initial shape and mobility of soft tissues, which will ensure the accuracy of the operation. The second advantage is the convenience of work. It is due to the fact that the force of laser action on soft tissues is always the same and is determined by the settings of the installation. And the depth of the cut with cutting tools always depends on the applied force of the surgeon. Therefore, working with a laser, a specialist has the ability to focus only on the direction of the laser beam. And the doctor does not have to worry about the sharp damage to the depth of lying tissue. The third advantage is security. When working with surgical scissors or a scalpel, the tools are always in the patient's mouth. And any movement of the patient can cause serious injury to soft tissues of the oral cavity. And if you consider that most children are prone to be afraid of surgical interventions, then any sudden fright can lead to sudden movements of the child's head. But, the work of the laser installation is completely controlled by the doctor with the help of a foot pedal. If the child is frightened and suddenly starts to move, the doctor will immediately react, release the pedal and the laser will stop working. The fourth advantage of laser franectomy is the absence of the need for suturing. Stitching is a long and responsible manipulation. When performing it, it is important to choose the thickness and material of the surgical thread correctly. It is necessary to carefully suture the wound and leave no gaps, it is important to produce a moderate. All these tasks require the patient's time, experience and calmness. 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 classical surgical operation. The fifth advantage is the positive attitude of children towards laser dentistry. This factor plays a very important role in the performance of frenectomy in pediatric patients. When they find out that they will be pruned with a bridle laser, most of them are waiting for the operation with considerable interest. At the stomatologist the child receives special protective glasses which together with a laser installation look very futuristic. As a result, the operation is painless and comfortable for a small patient.

Contraindications to the procedure

There are no special contraindications to the operation of pruning the bridle of the tongue. Any surgical operations are not performed if the patient has active inflammatory diseases. With pathologies of the endocrine, cardiovascular system, the question of individual medication preparation is considered. If it is possible, surgery will also be performed. In some situations, the operation is impossible under local anesthesia. Mental illness, fear of doctors and medical interventions, allergies to local anesthetics may be present in people of any age. Therefore, even if a simple operation is extremely necessary, then it is possible to perform it under anesthesia. As for the specific cutting of the frenum of the tongue, it is not recommended to conduct it before the course of myogymnastic procedures. After all, if the physical load of the frenulum contributes to its stretching, then surgery will not be needed.

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Consequences after the procedure

The pruning of the tongue bridle carries only positive moments, if it is performed according to the indications. Therefore, the consequences of surgery can be anticipated even before the beginning of surgical intervention. If a child is diagnosed with a speech defect and has not previously had a course of myogymnia, then the expediency of the operation is still in question. After all, problems with speech could be corrected in a more conservative way. And in the case when the cause of improper pronouncing of sounds is the disrupted work of the central nervous system, even the operation of frenuloplasty will prove ineffective. Moreover, it can aggravate the existing pathology.

When a correct diagnosis is made, a qualitative operation and control of the postoperative period, pruning the frenum helps normalize the function of speech. In combination with miogimnastika correct pronunciation of sounds occurs quite soon. If an orthodontic treatment is performed after the operation, aimed at stimulating the growth of the lower jaw, then it will also prove to be very effective. In adults, after the frenulum is cut, periodontal treatment is more productive than before surgery. If the patient has undergone surgery for further prosthetics, then orthopedic treatment is also 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 in execution, bloodless and painless. After performing Frenuloplasty, complications can be related to the doctor's mistakes or patient's failure to follow the rules of wound care. As for the complications provoked by the surgeon's actions, they can be associated with a violation of the technique of wound suturing. If the doctor puts less stitches than necessary, the wound will not be isolated from the oral cavity. This will increase the risk of attaching pathogenic microflora and the development of inflammation in the area of the tongue bridle. If the seams are unevenly stretched, then some areas of soft tissues will be pinched by suture material, while others will become excessively mobile. This moment can cause the displacement of the frenum of the tongue, which is an undesirable outcome of the performed operation. If the doctor's appointments are not observed, sometimes, purulent-inflammatory processes occur in the wound site. In this case, after cutting the bridle, the body temperature rises, there is a headache, drowsiness and other symptoms of intoxication. Often this is due to the fact that people can not refuse their routine, they continue to smoke, brush their teeth once a day and miss the appointment of prescribed medications. This puts the whole result of the treatment at risk and can lead to serious consequences. If you follow all the recommendations of the surgeon, the postoperative period will go according to plan and complications will not arise.

If the pruning of the frenum of the tongue was performed under anesthesia, a person may have a reaction for a few days to preparations for general anesthesia. In the first days after the operation, you can get sick, sleepiness, nausea, vomiting. These symptoms should gradually disappear within 2-3 days.

After cutting the frenum of the tongue with a laser, complications are rare and can manifest themselves as the formation of a postoperative scar. This is due to a violation of the technique of intervention or incorrect laser settings. In this case, you may need to repeat the operation.

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Care after the procedure

After pruning the frenum of the tongue in newborns, postoperative care is not needed.

If Frenuloplasty was administered to a child under general anesthesia, then a few hours after the operation the patient will depart from anesthesia. This can be manifested by emotional arousal, anxiety or vice versa, drowsiness and inhibition. Also, a child may experience thirst, nausea, vomiting, headache, pain and dizziness. Therefore, the child must rest for several days. It is necessary to pay attention to careful antiseptic treatment of the oral cavity. In the area of the performed operation there should be no foreign substances, the teeth can not tolerate plaque and food remnants. This can provoke the attachment of pathogenic microflora and cause suppuration of the wound. It is also necessary to refrain from consuming hot and spicy food for several days. If the healing process passes without deviations, then 3-4 days after surgery, you can start working with a speech therapist and conduct courses miogimnastiki.

After frenuloplasty under infiltration anesthesia, which was performed to a patient of a child or young age, care should be directed to maintaining cleanliness in the oral cavity. To do this, you can use a variety of soft antiseptics (chlorhexidine bigluconate 0.06%, hydrogen peroxide 3%, etc.). If the bridle pruning was performed in adulthood before prosthetics or complex treatment of periodontitis, the postoperative care will be slightly different. First, before such surgical interventions, people of middle and mature age 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 complete the course of taking antibacterial drugs before the deadline. After all, this can disrupt the process of regeneration of soft tissues and provoke inflammation. Also, at the time of the postoperative period, it is necessary to abandon bad habits. Alcohol inhibits the action of antibiotics, and smoking disrupts the recovery of soft tissues in the surgical intervention zone. If the patient has chronic diseases in the oral cavity, it is recommended to use antiseptic agents (infusions of chamomile, sage and other medicinal herbs), anti-inflammatory and antifungal drugs (Listerine, Givalex, Metrogil Denta gel). After a 4-5 day recovery period, you can consult a doctor about correcting speech defects, orthodontic treatment, prosthetics, etc.

Laser franectomy, in addition to preventive antiseptic procedures, does not require general and topical application of medicines. It is only necessary to ensure that you do not injure the hyoid area, and do not eat hot and spicy food in the first days after the operation.

Myogymnia

Myogymnia is a very important therapeutic and prophylactic procedure. It allows not only to fix the result of surgical treatment, but in some cases to avoid it.

If a child has a shortened bridle of the tongue and speech defects begin to develop, then the first thing to do is to take a course of gymnastic exercises. They promote the stretching of the mucous strand of the tongue, which can ensure the normalization of the speech function. Myogymnia can be held at home and at the speech therapist. In this case, there is a whole set of effective exercises. First - touch the tip of the tongue near the upper incisors with the tip of the tongue. Do not tear your tongue from the sky, open and close your mouth. Exercise should be done smoothly, without sudden movements. Ten repetitions will suffice. The second exercise is to push the language 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 as far forward as possible, and then alternately move it up and down (10 repetitions). The fourth task is to push the tongue as far forward as possible and hold it in this position for 5-10 seconds. The fifth is to push the language slightly forward and roll its tube. (5-10 repetitions). When performing the first four tasks, the language should be flat, relaxed. You should closely follow the technique of doing the exercises. The child must properly and qualitatively carry them out. Main principles: smoothness, small speed, large amplitude of movements. The first training should be controlled from the beginning to the end by the parents. To do this, you can sit in front of the child and ask him to repeat the exercise for you. Also effective is the training in front of the mirror, which provides visibility of the performance of articulatory gymnastics. In a speech therapist, the course of miogymnastic procedures will be supplemented with exercises for setting the correct pronunciation of sounds. With a careful and conscientious approach to this technique, after a month the bridle can stretch to the desired length. The child will learn to freely pronounce all the sounds, and you with a smile realize that surgery will not be required.

If the operation of pruning the tongue of the tongue has been performed, this does not mean that all the violations will disappear on their own. After the restoration of soft tissues in the area of the operation, the course of the gymnastic procedures is required. Exercises and the principles of their implementation do not differ from those that were set forth in the previous paragraph. It should also be noted the importance of the doctor's involvement in performing the gymnastics of the tongue after cutting the bridle. The specialist will be able not only to teach correctly to do the exercises, but also to determine when it is necessary to finish the course of procedures or change the treatment plan.

The operation of pruning the tongue fringe shows good results at any age. If you consult a competent doctor, follow his prescriptions and recommendations, then this surgical intervention will be a successful contribution to your health!

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