How to determine if a child has a short frenulum of the tongue and whether it needs to be trimmed

The frenulum of the tongue is a leathery arch that connects the taste organ to the floor of the oral cavity and consists almost entirely of connective tissue. If its length does not correspond to the norm, the child has problems with speech clarity, and it is impossible to eliminate the problem with medications. Gymnastics and massage can help with minor deviations, otherwise surgical intervention will be required.

Incorrect length of the tongue frenulum affects the clarity of a child's speech

Why does a child have a short frenulum?

Parents sometimes encounter the problem of a short hyoid or superior frenulum immediately after birth - infants have problems with sucking. Or at the age of 3–4 years, when the baby has difficulty learning some words because the defect prevents the normal movement of the tongue. The main reason for the development of pathology is a genetic factor.

Why a short frenulum is formed:

• intrauterine infection of the fetus;
• serious viral or infectious diseases that a woman suffered during pregnancy;
• abdominal injuries in expectant mothers;
• alcohol abuse during pregnancy, especially in the early stages;
• birth of a child after 35 years;
• poor environment, work in hazardous industries, frequent stress.

The cause of the abnormal structure of the frenulum of the tongue may be other factors of unknown etiology.

Intrauterine infection of the fetus is one of the reasons for deviations in the size of the frenulum in a child

Causes of pathology

The most common cause of this developmental anomaly is considered to be a hereditary factor. So, if one of the parents has a short lingual frenulum, in 90% of cases, the pathology will also be present in the child.

In addition to the hereditary factor, there are a number of reasons that can lead to this developmental disorder.

These include:

• severe toxicosis at the beginning of pregnancy;
• viral diseases suffered by a woman “in the 1st trimester”;
• the use of certain medications at the time of formation of the fetal jaw apparatus;
• nervous breakdowns and stress suffered by the woman during the gestational period;
• a woman’s work with particularly dangerous and potentially hazardous substances in the first half of pregnancy.

The age of the mother also influences the development of shortened frenulum pathology in a child. Women over 35 years of age are more likely to give birth to children with minor developmental anomalies.

This is due to the purely personal characteristics of the body.

Types of short frenulum in children

Pathological deviations in the structure of the frenulum are congenital in nature and may be associated with incorrect location or length. You can see what a regular and an abnormal fold looks like in the photo.

Normal and short frenulum of the tongue in a child

Ankyloglossia is an incorrect location of the hyoid fold, the upper end is too close to the tip of the tongue, while the length of the frenulum is normal.

Dyslalia - a frenulum of less than 2.7–3 cm is considered short, depending on the degree of deviation of the length from normal indicators; the disease can be mild, moderate and severe.

Their main features:

• light – the length of the frenulum is more than 1.5 cm, problems with speech are possible; special speech therapy exercises will help stretch the fold;
• average - less than 1.5 cm, first the doctor will prescribe speech therapy, if it is ineffective, surgery will be prescribed;
• severe - the length of the frenulum is less than 1 cm; this form of pathology can only be treated surgically.

With a complete short frenulum, the tongue completely loses mobility; upon examination, you can see that the taste organ is curled into a tube. A partially short sublingual fold is typical for infants - the connective tissue is just forming, the frenulum looks like a thin film.

Frenumplasty ranks second after tooth extraction among all oral surgeries; the intervention is performed under local anesthesia or even without anesthesia at all.

What does a normal and short frenulum look like?

If you suspect that your newborn’s ligament is not long enough, take a close look at it and analyze its condition. There are three main ways to determine a short tongue frenulum in a child:

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• A newborn with a normal ligament under the tongue easily sticks it forward and moves it to the sides. To check, you can touch the baby's lower lip with your finger. The baby will open his mouth, take out his tongue, and move it around in search of the breast. If the frenulum is not long enough, the newborn will not be able to stick out his tongue. It will raise the tip a little or, conversely, lower it down;
• It is impossible to touch the palate with the tongue with a short frenulum, but with a normal length a newborn does this without much difficulty. Babies usually make a lot of movements with their mouth and tongue. Gaining experience, mastering new sensations. If a child is hungry, the first thing he does is open his mouth and look for the breast. Therefore, you won’t have to wait long to analyze the condition of a newborn’s frenulum;
• The most obvious sign is the position of the child's tongue while crying. A newborn does this often, since he does not yet know how to express his dissatisfaction in other ways. With a normal length of the ligament, the tongue is raised up. If it is short in a newborn, when crying, the edges of the tongue rise, but the middle cannot. It is held in place by a ligament.

An accurate diagnosis must be made by a specialist: neonatologist, pediatrician, dentist, orthodontist.

Signs of a shortened frenulum

In a newborn, obvious deviations in the structure of the frenulum can be determined by a neonatologist in the maternity hospital. The baby has difficulty latching onto the nipple, he cannot suckle normally, which is why he may constantly cry from hunger.

In children under one year of age, the abnormal structure of the frenulum manifests itself in the form of frequent and prolonged feedings; the baby, when attached to the breast, begins to be capricious, arches his back, and a slight weight gain is observed. Infants with a short lingual fold make clicking sounds during feeding and may bite their breasts.

The second common sign of a short frenulum is speech defects, which are observed in a child at 3–4 years of age, and speech therapy exercises do not help improve the situation.

How to recognize frenulum pathology:

• it is difficult for a child to reach the upper palate and the front teeth on the upper jaw with the tip of his tongue;
• difficulties arise with quickly moving the tongue from side to side;
• the lower front teeth are located at a great distance from each other, the bite is formed incorrectly, the incisors turn inward;
• the tip of the tongue extended forward has a square, flat shape, or bifurcates in the middle;
• periodontitis develops;
• the child refuses solid food because it needs to be placed close to the root of the tongue, which provokes a gag reflex.

Problems with the frenulum may be indicated by the child’s unclear pronunciation of hissing, ringing sounds, and the hard letter “l.”

With deviations in the size of the frenulum, periodontitis develops

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.

Treatment without surgery at home

Conservative restoration of frenulum functions is possible with an incomplete short frenulum if its length is more than 15 mm. If the fold size is 1–1.5 cm, you can try treatment at home, but if the condition does not improve within 2–3 months, you will have to resort to surgery.

To correct the length of the frenulum, special exercises and massage are used; a speech therapist will show the correct execution, but parents will have to work with the child at home.

Exercises

There is a special articulation gymnastics that helps stretch the short sublingual fold. Many parents have already been able to evaluate the effectiveness of the exercises, but only with regular exercise.

Exercises for the short hyoid fold:

1. Move the tip of the tongue from the upper teeth to the throat, the lower jaw should remain in place.
2. Pronounce the sound “d” repeatedly and clearly, the tip of the tongue should rest against the upper teeth, and the mouth should be kept wide open at all times. To make the exercise easier, you can hold a pencil between your teeth.
3. The tip of the tongue alternately reaches towards the nose and upper lip, the tongue should be even, the jaw should be in place.
4. Use the tip of your tongue to touch the lower and upper teeth alternately.
5. Press your tongue firmly into the right, then left cheek.
6. Pour milk or jam into a small saucer and ask the child to pretend to be a kitten.
7. Press your tongue firmly against the roof of your mouth and open and close your mouth.
8. Click your tongue, pretending to be a horse.
9. Press the tip of your tongue to the roof of your mouth and hold the position for a few seconds.
10. Stick your tongue out as far as possible, try to reach your chin.

Special exercises help stretch the hyoid fold

All exercises must be done slowly with the greatest possible amplitude, the mouth should be wide open, lips stretched in a smile. Despite the simplicity of gymnastics, it is a heavy physical and mental load for the baby, so it is necessary to take short breaks during classes and conduct them in the form of a game.

Massage

Gymnastics should be supplemented with a special speech therapy massage; older children can cope with this on their own after several sessions.

How to request a massage:

1. Using the fingers of one hand, take the tip of the tongue, lift it up, and with the fingers of the other hand, use light stretching movements to move from the base of the fold to its end. The child's mouth should be wide open.
2. Hold the frenulum with two fingers, press the tip of the tongue with your thumb, and perform outward pulling movements.
3. Gently take the tip of your tongue with your fingers and pull it from side to side and out.

Speech therapy massage helps restore normal speech clarity

During gymnastics and massage, at the same time you need to practice sound production. While the fold is not stretched, the sounds ch, shch, d, t, l are played. After completing the stretching, you can move on to the sounds w, w, r.

Traditional Treatments

After a short frenulum has been corrected surgically, various measures are necessary to maintain the result. In this case, these are stretching exercises and speech therapy massage. By the way, the use of such techniques is recommended even when it is possible to do without surgical intervention.

Stretching exercises

Classes are held 5 times a day and last 5 minutes. It is better to do them more often, but not to delay them. We list the exercises for stretching the short frenulum of the tongue:

READ ALSO: what to do if a child has a short frenulum of the tongue?

• extend the tongue and move it from one corner of the mouth to the other;
• reach the lower and upper lips with the tip of your tongue;
• click your tongue, sucking it to the roof of your mouth and sharply tearing it down (you get a sound similar to the clatter of horse hooves);
• lick a drop of jam from your upper lip with your tongue;
• open your mouth wide and run your tongue across the roof of your mouth away from your teeth;
• stretch your mouth in a smile and touch the tip of your tongue first to the upper and then to the lower teeth;
• close your mouth and alternately place your tongue on your right cheek, then on your left;
• close your mouth and stretch your lips into a tube;
• close your lips and stretch them into a smile;
• stretch out your lips and smack them at the same time;
• Let the baby lick the spoon.

Speech therapy massage

Speech therapy massage gives good results, although it does not bring pleasant sensations to the child. The doctor carries out the procedure with thoroughly washed and disinfected hands. What is speech therapy massage:

1. The frenulum is pinched with the index finger and thumb. Then, with closed fingers, you need to run along the jumper from bottom to top.
2. With your middle and index fingers, grab the hyoid septum and fix it, and with your thumb, press on the front area of ​​the tongue and slightly pull it outward.
3. Hold the tip of your tongue with your thumb and forefinger and pull it up and down. Then use your index finger to forcefully pull the bridle upward.
4. Place a small ring on the tip of your tongue (you can cut it off from a pipette). Then open your mouth and press the ring to the sky, then close your mouth. Repeat the exercise 3 times a day for 10 approaches.

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At what age is pruning done?

With a shortened frenulum, the lower jaw is formed incorrectly, problems arise with the bite and formation of the dentition, breathing, swallowing, due to severe exposure of the gums, dental pathologies develop - all these factors are indications for surgical intervention.

Some experts insist on performing frenuloplasty before speech therapy problems arise, but sometimes scars appear at the site of the incision against the background of the child’s active growth that will need to be removed.

Other doctors recommend surgery for children after 4 years of age if there are obvious problems with speech. But the problems will not disappear immediately after the intervention; the child will have to study for a long time to speak well.

If the baby has problems with sucking, then the operation must be performed within a few days after birth.

Short frenulum of the penis

A congenital anomaly (or as a result of trauma to the penis) in which the fold of the foreskin connecting it to the head of the penis is short. A short frenulum of the penis prevents the displacement (removal of the head from the preputial sac) of the foreskin beyond the coronary groove, causes pain during erection, and is an obstacle to sexual intercourse. The fact that the foreskin does not move beyond the groove contributes to smegma (the secretion of the foreskin glands) and the development of the inflammatory process in the preputial sac. In addition, a short frenulum strongly bends the head of the penis, which leads to tears during sexual intercourse, accompanied by significant bleeding.

Surgery

The only solution to this problem (pathology) is surgical treatment. With a short frenulum, one of the most common operations on the penis is performed - Frenulotomy - plastic correction of a short frenulum (dissection and lengthening of the frenulum of the penis).

Frenulotomy is performed on an outpatient basis under local anesthesia. The foreskin is pulled back proximally. The frenulum is pulled and cut in the transverse direction to such a depth that the foreskin can be freely pulled back (a cut 0.7-1.0 cm long). After hemostasis, 2-3 interrupted sutures are applied to the edges of the wound in the transverse direction, followed by the application of an aseptic dressing.

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Types of pruning

Operations to eliminate frenulum defects are carried out in different ways, all of them are practically painless, low-traumatic, the child tolerates them well and recovers quickly.

Trimming has a number of contraindications - oncological and infectious pathologies, problems with blood clotting, inflammation of the oral mucosa, caries, pulpitis, and other dental diseases. The operation is not performed on children with mental disorders, osteomyelitis, or cerebral disorders.

Frenuloplasty

The operation is performed on children over 2 years of age; it is performed under general anesthesia; during the intervention, the fold may be cut, removed, or the attachment site may be changed. You should first do tests for coagulability and blood type.

Progress of the operation:

1. A small triangular piece of fabric is cut from the fold.
2. Then they sew it back, forming a fold of the correct length.
3. The duration of the operation is 10 minutes.
4. The wound heals within 24 hours.

For several days, the child can only eat warm, soft foods; the rules of oral hygiene must be strictly observed.

Before and after frenuloplasty of the lingual frenulum

Scalpel dissection

Frenulotomy - the operation is indicated for small children under 9 months, in whom the fold is a thin white film in which there are no blood vessels.

Progress of the operation:

1. An incision is made at a distance of a third of the length of the frenulum, counting from the lower teeth.
2. The edges of the mucous membrane are brought together and sutured.
3. A scalpel or surgical scissors is used for dissection; anesthesia is not required. There are rarely minor bleedings that stop on their own when the baby is put to the breast.
4. Rehabilitation is only a few hours.

Tongue frenulotomy procedure

This operation is often performed in a maternity hospital; the younger the child, the fewer nerve endings and blood vessels in the tissues of the frenulum, which significantly speeds up the recovery process.

Frenulectomy - the essence of the operation is the same, but the sublingual fold is fixed from above with clamps, and the tissue is dissected under the tongue.

Laser excision

The laser method is considered the most gentle method of plastic surgery of the frenulum of the tongue. The main advantages are the absence of bleeding, no need for stitches, all manipulations take no more than 5–7 minutes, there is practically no pain, and the child recovers quickly.

Laser trimming of the tongue frenulum is fast and free of bleeding

During the intervention, a device is directed at the fold, which forms a beam of the required thickness - under the influence of high temperatures, the tissues die.

After the operation, medications are applied that accelerate the regeneration process; after 2 weeks, the child does not feel any consequences of the plastic surgery.

Elimination and prevention of the problem

Treatment of a short frenulum is not particularly difficult. The surgery to correct the problem is called frenulotomy. It lasts no more than an hour and does not cause any consequences upon completion.

• Treatment is carried out as follows.
• The patient is scheduled for surgery on a specific day.
• There is no preparation for it; the patient’s entire task is to perform normal hygienic procedures and report to the facility for surgery.
• The patient is placed in the appropriate place, the doctor treats the area for surgery with a disinfectant solution, after which the patient is given anesthesia, usually local, although an exception can be made for children.
• After the procedures, the doctor cuts the frenulum across, if necessary, suturing it, eliminating part of the scar.
• After several days, the incision site will heal, a soft scar will form, and the frenulum will become long.

After the operation is completed, the patient can forget about the problem and lead a normal life, but will need to lubricate the sore spot for some time. The ointment is prescribed by the doctor. After a certain time specified by the doctor, the patient will need to return for an appointment to ensure normal healing. It is worth noting that until healing the patient is advised to abstain from sexual intercourse.

For the purpose of prevention, it is recommended to do the following. It is necessary to show your child to a pediatrician starting from the age of 3, and include control of the foreskin in the examination program. In addition, the child should be taught to care for his private parts and move the foreskin. Adult men should promptly consult a doctor if problems arise . You should not try to treat yourself at home.

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Possible complications after pruning

Usually, surgery to correct the frenulum occurs without any special consequences for the child. Complications in the form of inflammation, fever and pain occur only with improper wound care. If plastic surgery was done after 6 years, scarring may form, which will require repeated intervention.

A high temperature after cutting the frenulum indicates the development of inflammation

Frenum of the lower lip

This is the most unique and “mysterious” bridle, which can be forked or completely absent. When it bifurcates, doctors use phreectomy - excision of excess mucous cord.

To evaluate the frenulum, doctors evaluate its attachment to the mucous membrane of the gums. Normally, it should be attached a few millimeters below the neck of the central incisors, and its direction should coincide with the central line passing between the incisors.

What are the dangers of this condition?

This frenulum determines the depth of the vestibule of the oral cavity. An important indicator for full functioning. If it is short, then sooner or later the following complications are diagnosed:

• persistent inflammation of the gums, which becomes complicated and develops into periodontitis;
• gum retraction – exposure of sensitive areas of the tooth, followed by the formation of hyperesthesia;
• caries in the gingival area or tooth root caries.

Dentists do not set strict limits on when exactly the frenulum on the lower lip can be trimmed. To correct the situation, all three types of surgical correction of the frenulum can be used.

Alena Paretskaya, pediatrician, medical columnist

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Forms and causes of the formation of a short frenulum of the foreskin

Experts distinguish two forms of the disease:

Congenital. Develops from birth, transmission of the disease at the genetic level is possible. It is not always possible to recognize the cause of the disease, since the anomaly can only be noticed in adolescence.

Acquired. Can be obtained in the following cases:

• inflammatory processes and concomitant diseases of the genitourinary organs;
• development of sexually transmitted infections;
• injury to a healthy frenulum and its further scarring;
• tight underwear;
• balanoposthitis, which is accompanied by inflammation of the surface of the head and foreskin.

We invite you to look at a photo of a short frenulum on the penis in men.

Causes

Basically, a shortened frenulum is congenital in nature and is formed during intrauterine development. Boys are born with this anatomical feature, but by the time of puberty there are no complaints. The first symptoms appear with sexual arousal and the onset of erection.

In addition to the congenital form, there is an acquired shortening of the frenulum. Factors that contribute to the development of this condition are:

• mechanical injuries (tears of the frenulum due to rough sexual intercourse, masturbation, intense participation in certain sports, wearing too tight underwear);
• inflammatory diseases of the penis (posthitis, balanoposthitis);
• sexually transmitted diseases (rash on the head of the penis, itching, purulent discharge, etc.);
• various infections, infection with fungi that cause thrush;
• diabetes;
• lack of personal hygiene;
• inflammatory lesions of the genitourinary system.

Doctor Komarovsky's opinion

Famous pediatrician O.E. Komarovsky believes that the operation should be carried out only when indicated. The doctor identifies 2 main problems associated with impaired frenulum length:

• problems of natural feeding;
• incorrect pronunciation of sounds.

Surgical intervention in the first case is prescribed by a pediatrician, in the second - by a speech therapist. The operation is performed by a dental surgeon, but he does not make the decision about the need for the procedure. If the baby does not have problems with feeding, the operation may not be performed; perhaps, to stretch the bridge, it will be enough to perform special exercises at an older age.

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What are the consequences of prolonging the problem?

Surgery is best done at an early age. Namely, when problems with diction have already appeared, but there is still time to correct them with the least amount of time and labor. In children, the development of the speech center in the brain closes by the age of five. After this, teaching a child to speak correctly will be much more difficult. Therefore, in order to save both your own and his strength, it is better to perform a basic operation as soon as a specialist has given a referral for it. This will reduce the child’s problems in the future and help him adapt to society faster and easier.

Plastic surgery of the frenulum of the foreskin, or frenulotomy

Often a man finds out that he has a short frenulum of the penis after the start of sexual activity. Sometimes the first sexual intercourse, which is also stressful, is accompanied by a rupture of the frenulum, which can lead to fear of sex and erectile dysfunction. Although, if you seek help in a timely manner, you can undergo plastic surgery of the foreskin frenulum.

There is an opinion that with a short frenulum, a consultation with a sexologist and an examination by an andrologist are not necessary - during sexual intercourse, a rupture will occur and the problem will be solved. Indeed, in some men the frenulum completely ruptures and its length becomes sufficient. Most often, an incomplete rupture occurs, a scar appears, the frenulum continues to tear and with subsequent contacts, the nerve endings are injured.

The operation to plasticize the frenulum of the penis takes no more than 20 minutes and is performed on an outpatient basis. If the operation is carried out preventively to avoid rupture, then the frenulum is cut transversely. If there has already been a rupture or scar tissue has formed, the doctor will perform an excision of the scar. The excellent aesthetic effect allows the postoperative scar to be invisible, since it becomes a continuation of the natural suture that runs along the lower edge of the penis and scrotum.

How quickly does healing occur after foreskin frenuloplasty?

Complete healing occurs after a few days; during this period it is necessary to follow the doctor's instructions. And although you will not feel discomfort 2-3 days after the operation, any form of sexual activity is possible after 2 weeks.

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Speech problems

Impaired diction due to ankyloglossia is observed because the tongue cannot reach the palate and upper teeth. Because of this, it is difficult for a person to pronounce quite a lot of letters: “Zh”, “Sh”, “Shch”, “L”, “R” and “Ch”. If there are problems with speech, it will probably not be possible to correct them with the help of articulation exercises and classes with a speech pathologist. Conservative methods will have a visible result only in the case of a slight disorder in the pronunciation of certain sounds.

A speech therapist can help improve speech, but if experts recommend surgery, then they are not able to cope with the problem solely with the help of methodological lessons. Let us note once again that ankyloglossia does not always provoke speech defects. If they are not there, the child does not need to trim the frenulum of the child’s tongue. Moreover, the operation itself will not make a person’s speech intelligible and correct. After the procedure, the patient will have to work with speech therapy specialists for at least six months.

Surgical intervention

The dissection of the short frenulum, located under the tongue, is carried out either immediately after the birth of the baby, or much later, already at school age.

Treatment of a newborn

Having discovered that the baby cannot fully suckle at the breast, the maternity hospital doctors decide to trim the short frenulum. A young mother needs to be calm about the upcoming operation. It passes very quickly, literally in a few (from 5 to 20) seconds. The baby does not feel pain at all, not only because of the lightning-fast manipulation, but also because there is not a single nerve ending in the fold that sends pain signals.

The surgeon performs the operation in front of the mother, the baby is immediately put to the breast, and in most cases he does not even have time to cry. Special surgical scissors can be used to trim the frenulum of a baby. It is also possible to use a laser scalpel. There are no sutures after surgery performed with one of these instruments. In a couple of hours, the child will fully recover, and the mother will understand that he is not experiencing any consequences of the operation.

Treatment of a school-age child

If, for various reasons, the baby’s frenulum was not cut, and she was unable to stretch properly on her own, if necessary (speech therapy problems), the speech therapist and dentist make a joint determination about the need for surgery. Now the intervention is carried out after local anesthesia, after the dissection, stitches are applied, and a special diet is prescribed. The procedure also requires special training of the frenulum using special exercises.

What it is?

The frenulum should be of such length that the tongue can move freely in the mouth, reach the upper teeth and move forward with ease. Difficulty performing these actions indicates that a person has a short frenulum of the tongue. In medicine, this pathology was given the name “ankyloglossia”.

5% of newborns have to face a similar problem; an interesting fact is that ankyloglossia occurs three times more often in men than in women. There are cases when the tongue is almost completely immobilized due to the fact that the mucous fold that forms the frenulum is too short. This condition is called “complete ankyloglossia”.

If the frenulum allows the organ to move, but to a limited extent, then they speak of partial shortening. Immediately after a person is born, the tissues that make up the fold are thin and elastic, they lack blood vessels and nerve endings. Therefore, in case of gross defects, the frenulum is incised directly in the delivery room. Sometimes the neonatologist may decide not to injure the baby, but the baby will be closely monitored in the future.

Traditional surgery

The child's frenulum under the tongue is trimmed using surgical scissors. It's a matter of a second, but it can have consequences. When an incision is made on a newborn, the tissues grow together quickly and the risk that the scar will harden is minimal. In older children, the procedure is not so painless. The wound may bleed for some time and cause discomfort to the child, although it still heals quickly.

The problem is that after a traditional operation with scissors, a small defect may appear on the frenulum, which in the future will have to be solved with plastic surgery. Its essence is that the scar is smoothed, cutting it along its entire length, then a correct submucosal flap is formed and the site of the lingual frenulum is transferred to its proper place. The new “structure” is secured using self-absorbing sutures. The surgeon must perform the operation very carefully to avoid damage to the excretory ducts of the salivary glands.

Symptoms

For those who are giving birth for the first time or are just planning to have children, the following factors should not be ignored when the baby is born:

• the baby makes loud noises when sucking milk;
• often bites the nipple, causing pain to the mother;
• asks for the breast too often;
• if the baby is capricious when feeding;
• reaches for the breast, but refuses to suck milk;
• the child is slowly gaining weight.

If you do not immediately pay attention to the symptoms described above, then the child may experience complications in the future. The teeth will grow incorrectly and periodontitis or gingivitis will appear.

In addition, problems may arise with the articulation system, which often causes the baby to be underdeveloped. This can also affect spoken speech, which is hindered by insufficient mobility of the lower jaw.

Therefore, it is better to eliminate these symptoms immediately, since after the formation of the body, after a few years, it will no longer be meaningful.

When is the best time to have surgery?

The operation is best performed before the child is one year old. During a routine examination of the baby, the pediatrician’s task is to promptly recognize the cause of the baby’s anxiety and prescribe appropriate treatment. If time is lost and parents see a defect in the bridge after 3 years, you need to contact an orthodontist or pediatric surgeon. When the child is 5 years old or older, the surgeon explains that the operation is inadvisable, since the child has already developed the skills to pronounce the scale. Even a good outcome of the operation does not mean that the child will not have a lisp in the future.

Laser treatment

There are several methods for correcting frenulum pathology:

• correction exercises;
• laser surgery;
• surgery.

Method	Description	Contraindications
Frenulotomy	The operation is performed for mild to moderate anomalies. This is cutting the membrane and suturing the edges of the mucous membrane.	Small amount of tissue to cut.
Frenulectomy	The same operation as frenulotomy. The difference is in making the cut from the incisor side.	Hemophilia (blood clotting disorder)
Frenuloplasty	This technique is performed when the anomaly is severe. Triangular-shaped tissue is cut out from the mucous membrane and then sewn on.	Presence of oral infections.

Laser cutting is also used to correct frenulum pathology. This treatment method is more gentle and therefore more suitable for younger children.

Advantages of laser surgery:

• fast healing;
• sealing the wound;
• no seams;
• no bleeding;
• sterilization of incisions;
• duration of the operation (10 min.).

Laser treatment occurs without complications. After the procedure, you must follow all the doctor’s instructions (the same as after surgery with a scalpel).

Cases when a child cannot stick the tip of his tongue beyond the teeth or lick his upper lip are considered serious and require surgical intervention. For a more accurate diagnosis, doctors resort to the E. Haselbaker test.

In infancy and preschool age, indications for surgery are cases when the child experiences significant difficulties during feeding, when there is obvious deformation or the formation of a pathological bite.

At the same time, the relevant question is at what age is it better to trim a short frenulum of the tongue. There is no definite answer; it all depends on the severity of the anomaly. Sometimes doctors recommend surgery as early as possible, in the first days after birth.

In other cases, on the contrary, it is recommended to wait some time until the child’s speech skills begin to develop. Doctors make this decision based on diagnostic data and if there is a chance to correct the short frenulum with speech therapy exercises or massage.

At the same time, the procedure for cutting the frenulum is quite simple and painless. The intervention is carried out under the influence of local anesthetics, and the healing process takes a couple of days.

In infancy, children tolerate frenuloplasty more easily. The operation is performed using medical scissors and a laser scalpel. At a more mature age, with a thick or completely fused frenulum, sutures may be necessary after dissection.

Moreover, after recovery, the child will definitely need qualified help from a psychologist and regular classes with a speech therapist.

What if the bridle is short?

The main disadvantage of oral frenulum is their insufficient length. Should we pay attention to this? Is a frenulum that is too long in newborns a pathology? Doctors believe that the abnormal structure and location of the frenulum should not be taken lightly, since the defect, which some parents perceive as a peculiar feature, can have serious consequences.

Is surgery necessary?

Trimming the short frenulum of the tongue (frenulotomy) is a simple operation. It requires only local anesthesia and is rarely accompanied by heavy bleeding. Almost immediately after the intervention you can eat, drink, and talk.

Surgical treatment is necessary for severe limitation of tongue mobility. In the case of moderate limitation, the appropriateness of the operation is determined by the attending physician. A mild degree is corrected therapeutically (sessions with a speech therapist, speech therapy).

Indications for surgery to trim the short frenulum of the tongue:

1. Severe degree of limitation of tongue mobility;
2. Average degree of limitation of tongue mobility with unsuccessful therapeutic treatment;
3. Impaired nipple latching during breastfeeding, insufficient weight gain in an infant;
4. Forming malocclusion;
5. Emerging dentition displacement;
6. The need for orthodontic structures (removable dentures);
7. The need to install implants (dentures).

If in infancy the child had no problems with eating, the dentition is formed correctly, and a speech therapist first reports about ankyloglossia, it is recommended to first undergo a course of speech therapy (articulation gymnastics).

Classes with a specialist during such treatment are aimed at stretching the hypoglossal ligament. In 90% of cases with moderate and mild ankyloglossia, the frenulum of the tongue is amenable to therapeutic intervention, and surgical intervention is not required.

Parents should remember that articulation gymnastics and consultations with a speech therapist will be necessary for the child even after cutting the hypoglossal ligament. Sometimes planned surgical treatment of ankyloglossia has to be postponed due to contraindications.

Contraindications to surgery if necessary:

1. Oncological diseases;
2. Blood diseases;
3. Acute infectious processes;
4. Stomatitis, gingivitis;
5. Foci of infection in the oral cavity before sanitation.

Trimming the frenulum of the tongue at a young age is usually limited to a simple dissection (frenulotomy); in children over 5 years of age and in adults, plastic surgery of the sublingual fold may be required.

A short tongue frenulum in a child can be easily corrected surgically. Before performing the operation, the specialist pays attention to the age of the child, the degree of complexity of the pathology and its location.

Removal of the defect is performed under local anesthesia. The surgeon makes an incision with a special instrument and then stitches it. There may be some slight bleeding. This procedure takes about 30 minutes.

In this case it is necessary:

• exclude hot and spicy foods from the diet;
• carry out oral hygiene;
• perform special exercises to quickly resolve scars;
• maintain speech peace;
• consult a speech therapist to eliminate speech deficiencies.

The decision about the need for surgery to correct the defect should be made by doctors such as an orthopedist, speech therapist and surgeon. It depends on when ankyloglossia was detected (the age of the child), as well as on the individual characteristics of the anomaly.

Doctors often prescribe surgery 1-2 years after the defect is discovered, since during this time the frenulum can stretch to the required size as the baby grows.

Indications for which surgical intervention is recommended:

• difficulty eating;
• improperly formed bite;
• displacement of a number of teeth;
• speech defects (if other methods do not help).

Doctors recommend surgery to eliminate frenulum pathology for children under 1 year of age. The younger the baby, the easier the procedure will be for him. At this age, the membrane is weak and has no capillaries or nerve endings. The operation is performed without anesthesia.

If a child over 4 years of age has speech impediments, and stretching exercises for the frenulum do not help, it is necessary to solve the problem surgically. At this age, the procedure causes discomfort as well as pain. The operation is performed using local anesthesia and suturing.

Exercises for correction

In children with mild pathology, special exercises can correct the defect at home. Speech therapists have developed a whole set of highly effective exercises that help stretch the shortened frenulum of the tongue. If they are carried out systematically and all recommendations are followed, surgery will be avoided.

Set of exercises:

1. Swing. Open your mouth in a smile. Alternately touch the tip of your tongue to the upper and lower rows of teeth.
2. Football. Alternately push with your tongue, then the left cheek, then the right.
3. Painter. Open your mouth in a smile. Move your tongue along the palate from the teeth to the larynx. The jaw should be motionless.
4. Kitty. Place jam or other delicacy on a saucer. The child needs to lick it off without using his lips. This task strengthens the muscle ligaments of the tongue.
5. Drum. Place your tongue on the top row of teeth and repeat the letter “d” clearly and quickly with your mouth open. To prevent the child from closing his mouth, it is necessary to help him with some object, such as a pencil, to keep it open.
6. Harmonic. With an effort, press your tongue against the roof of your mouth and, without moving it, alternately open and close your mouth.
7. Horse. Make clicks with your tongue, copying the sound of hooves. The lower jaw is immobilized.
8. Fungus. Press your tongue against the roof of your mouth with force (the tongue is the cap of the fungus, and the membrane is the stem).
9. Open your mouth in a smile. Touch your tongue to your nose and then lower it to your upper lip. At the same time, do not move your lips.
10. Touch your tongue to your chin. The lower you can do this, the sooner the membrane will stretch.

When performing such gymnastics, you can use additional objects (a teaspoon, straws, pencils) to help your child achieve results faster.

Short frenulum of the uvula in newborns and breastfeeding

Short lingual frenulum in newborns and breastfeeding April 16, 2012 | Category: Problems: lactostasis, ...| Author: Natalya Razakhatskaya Before the era of artificial feeding and bottle feeding, the problem of cutting a short frenulum did not arise - if the midwife or doctor who delivered the baby discovered a short frenulum in a child, it was immediately cut so that the baby could attach himself to the mother’s breast without any problems. The features of this simple manipulation have been described in many medical and surgical books. But as birth moved from home to hospital and immediate separation of mother and baby after birth became routine, breastfeeding became perceived as unreliable and difficult to achieve. Once bottle feeding became the cultural norm in many industrialized countries, medical attitudes toward the problem of frenulum brevis changed dramatically. More and more pediatricians began to say that tongue movements are not important during sucking and, accordingly, there is no need to trim the short frenulum. The description of the treatment of short frenulum was removed from textbooks. For any problems with breastfeeding, they began to blame solely the shape of the mother’s nipples and began to instruct women to actively massage and stretch their nipples during pregnancy. Modern research has proven the complete uselessness and even harm of such manipulations. Only now, when the need and norm of breastfeeding is no longer disputed by almost anyone, attention has begun to be paid to the problem of a short frenulum. However, there are still many myths and fears on this issue, especially among parents. After surfing the Internet, I found virtually no useful information for parents regarding identifying and solving this problem. I myself, to be honest, was completely in the dark about this issue until I went to the ILCA conference, where I met the author of the recently published book “Tongue-Tie” - Alison Haselbaker. During the master class, Alison convincingly proved by personal example that a short frenulum that is not trimmed in time can cause a lot of trouble even for an adult, depriving him of the ability to eat, speak, sleep normally and have healthy teeth. By the way, the author of the book finally decided to cut her frenulum at the age of 40, without anesthesia. “It’s surprising, but I didn’t feel any severe pain! After the procedure, for the first time I was able to properly reach my side teeth with my tongue and eat without effort,” Alison shared her impressions at the conference. However, she had to work with a speech therapist for a long time before regaining all the functions of her tongue. After that, she decided that she would definitely write a book on this topic in order to dispel many myths on this matter. By the way, I managed to get an autographed copy of the book as a gift for all Belarusian breastfeeding consultants. So let's learn English and read the source! What is a short frenulum? A short frenulum (ankyloglossia) is an embryological rudiment of tissue that attaches the tongue to the floor of the mouth and ideally should be absorbed by birth, but this does not always happen, especially when the baby is born prematurely or someone has a short frenulum in their family. It also happens that the upper frenulum remains too tight, attaching the upper sponge very tightly to the upper gum in the middle - then the baby is unable to straighten the upper sponge normally when sucking.

A short frenulum in an older child. Photo: tonguetie.net What breastfeeding problems may indicate a short frenulum? The tongue plays a very important role in the process of breastfeeding and it is its correct and coordinated movements that ensure calm feeding and good stimulation of the breast. If a short frenulum holds the tongue and restricts its free movement, this affects breastfeeding.

• The baby cannot attach to the breast or hold it in his mouth for a long time
• Too long and inactive feedings during sleep (more than 30 minutes) and unsatisfied crying after that
• Poor weight gain
• Chewing or biting nipples, angled or flattened nipples, severe pain when feeding
• Smacking while feeding
• Frequent regurgitation, bloating
• Frequent stagnation of milk, inflammation of the mammary gland

Problems in older age?

• Sleep problems, apnea
• Salivation
• Bite problems, caries
• Indigestion, gas, belching
• Speech problems

How to determine a short frenulum?

Most often, this can be done by simply looking into the baby's mouth - the frenulum is attached to the tip of the tongue, bifurcating it in the shape of a heart and is clearly visible, especially when the baby is crying.

The child cannot raise his tongue well to the upper palate or stick out behind his lower lip. The tongue often appears humped when the back is raised and the front is pressed to the floor of the mouth.

Often a short bridle goes in combination with the so-called “Gothic” palate. For a more detailed diagnosis, you can use the test to assess the functionality of the hyoid frenulum by Professor Alison Haselbaker or other authors (see below).

In any case, it would be a good idea to go to the dentist or orthodontist. The Haselbaker test has the advantage of assessing not only the appearance, but also the functionality of the tongue, since sometimes the short frenulum is very elastic and does not cause problems to its owner, and sometimes it is deeply hidden.

How is frenotomy performed - surgery to cut the frenulum?

The operation is performed by a dental surgeon in his office. It reliably fixes the baby's face and cuts the frenulum using special scissors or a laser. No general anesthesia, no blood, no stitches! The baby can be put to the breast immediately!

The cutting itself takes no more than one minute and children often cry not from pain, but from the strong fixation of the face and tongue. This is unpleasant, especially under the light of a bright lamp, but everything is forgotten by my mother’s boobs in a couple of minutes. And what a relief mom feels when feeding no longer causes pain!

Test

Do I know everything about breastfeeding? Take the test and test yourself. YandexDirect

• A fairy tale about your child! A book with fairy tales and pictures about your child. Price from 1540 rub. www.tutskazka.ru

Place an advertisementAt what age can a bridle be trimmed?

This can be done from the first day of life. There is no point in waiting until 3-6 months to do this trimming when it comes to breastfeeding success.

How to care for the wound after surgery?

There is no need to treat it specially, only in special cases, which your doctor will certainly inform you about. To avoid re-fusion and to force the tongue to move correctly, you can use special exercises to stretch and extend the tongue.

American dental clinics even provide special disposable spatulas, which are convenient for lifting the tongue and monitoring the wound. But this, of course, can be done with two clean fingers - several times a day for 1 week while the scar is forming.

Photo cwgenna.com. By the way, at this link you can read in English about quick diagnostics with photographs.

The influence of the upper frenulum on the development of caries of the anterior teeth in infants

Breastfeeding in itself does not pose a risk of developing childhood caries. However, in combination with incorrect positioning of the upper frenulum, HF can lead to caries of the upper front teeth in infants. This conclusion was made by pediatric dentist Laurence Kotlow after observing 350 children aged from birth to 3 years.

In its normal position, the upper frenulum is located at the gum line or even higher. Incorrect formation of the frenulum occurs when it is attached between the front incisors to the very base of the gum. This can lead to the fact that the baby may have problems attaching to the breast or the attachment may become very painful. In addition, under the influence of the frenulum, a pocket is formed inside under the upper lip, where milk constantly accumulates, which ultimately serves as a good breeding ground for bacteria.

If you find such an upper frenulum in your baby and plaque begins to appear on the teeth, it is necessary to organize good care for the child’s first teeth, namely, wipe them with regular gauze moistened with water several times a day. If, despite your actions, the child develops thinning of the enamel on the teeth, black or white spots, be sure to show the child to a pediatric dentist. Alternatively, such a bridle can be trimmed in the same way as the lower one.

Test to assess the functionality of the hyoid frenulum for health professionals and parents

Test author: prof. Alison Haselbaker, IBCLC

General rules: 1. Respect the child and do not do the test if the child shows symptoms of “oral aggression” (thrusts out a finger, gets very anxious, vomits) 2. Do the test gently, calmly and as quickly as possible. 3. Do not perform the test if the baby has never breastfed before.

Functional Parameters

1. Lateralization of the tongue (the ability of the tongue to turn from side to side) Place your finger in the middle of the lower lip and move it first to one corner of the mouth, then to the other. 2 The tongue follows the finger completely 1 Only the root of the tongue, but not the tip 0 The tongue does not move to the side

2. Raising the tongue to the upper palate 2 The tip of the tongue rises to the middle of the oral cavity without the participation of the lower jaw 1 Only the edges of the tongue rise to the middle of the oral cavity 0 Does not rise at all OR rises only when the lower jaw closes AND/OR the middle of the tongue forms a fossa when raised

3. Pull the tongue forward We move our finger from the middle of the lower sponge to the child’s chin 2 The tip of the tongue reaches the lower sponge 1 The tip of the tongue reaches only the lower gum 0 The tip of the tongue does not reach the gum OR the middle of the tongue rises strongly upward AND/OR a dimple appears

4. Smoothing the tongue We put a finger in the mouth and touch the upper palate with the pad until the baby begins to suck. 2 Complete smoothing of the tongue under the finger 1 Not complete, part of the tongue is arched 0 No smoothing

5. Sucking reflex We put our finger in the mouth and touch the upper palate with the pad until the baby begins to suck. 2 Wraps the finger tightly, along the entire length of the tongue 1 Wraps the finger not very tightly, only with the edges of the tongue 0 Cannot wrap the finger or very loosely

6. Peristalsis of the tongue (progressive contractions) Place your finger in the mouth and touch the upper palate with the pad until the baby begins to suck. 2 Full contraction of the tongue from tip to root 1 Not complete: from root to tip 0 No contraction OR tongue thrust

7. Snapping the tongue back Place your finger in the mouth and touch the upper palate with the pad until the baby begins to suck. 2 No 1 Occasionally 0 Often or with every sucking

Appearance

8 Appearance of raised tongue 2 Round OR square 1 Slightly bifurcated tip of tongue 0 Heart-shaped tongue

9 Length of frenulum when tongue is raised 2 more than 1 cm OR absence of frenulum 1 about 1 cm 0 less than 1 cm

10 Elasticity of the frenulum 2 Very elastic 1 Not very elastic 0 Not at all elastic

11 Attachment of the frenulum to the tongue 2 Attached 1 cm beyond the tip of the tongue 1 Attached to the tip of the tongue 0 Makes an indentation on the tip of the tongue OR attached under the mucous membrane of the root of the tongue

12 Attachment of frenulum to inferior alveolar ridge 2 Attachment to floor of mouth OR far behind inferior alveolar ridge 1 Insertion just behind inferior alveolar ridge 0 Attachment to inferior alveolar ridge

Treatment recommendations based on 14 points test – Excellent tongue functionality despite appearance.
There is no need to trim the bridle. 11 points – The functionality of the language is good, as long as the appearance scores at least 10 points. Less than 11 – The functionality of the tongue is weak, so trimming the frenulum is necessary if the appearance scores less than 8 points. lactostasis symptoms and treatment