Plastic surgery of the frenulum of the lip or tongue. When and how they are carried out. Questions for the doctor.

What pathologies require solutions?

Normally, the frenulum of the tongue starts from the tip of the organ and ends in the area of the lower incisors. It is located exactly in the center (bottom). These are the perfect sizes. The main pathology that occurs is a shortened frenulum, which leads to limited mobility of the tongue.

As for the frenulum of the lip (pathologies are mainly found on the upper one), then normally it should be located between the front incisors and at the base of the lip. Such a film can be very short, which will lead to tension on the mucous membrane, or excessively large and will overlap the front teeth.

Due to such pathologies, a complex of problems arises, without eliminating which you risk creating serious troubles in the child’s life. And they will have to be resolved over more than one year.

When is tongue frenulum trimming required?

The frenulum of the tongue is a small elastic membrane connecting the tongue to the oral cavity. The frenulum is responsible for important functions of the tongue: movement, breathing, swallowing, speech. This disorder is called ankylogloxia.

The normal development of the lingual frenulum begins centrally, at the root of the tongue, and ends at the lower incisors. The rest of the arrangement is a deviation. There are several deviations in the development of the frenulum:

Short bridle. The tongue becomes inactive and leads to improperly formed speech and jaw deformation.
Incorrectly positioned frenulum. Reduces motor activity of the tongue.
Long frenulum under the tongue. It can be located at the tip of the tongue and affect the swallowing process, disrupting nutrition.

Problems with the development of the tongue frenulum are a congenital pathology. And it is hereditary in nature. May occur due to problems during pregnancy.

Trimming the frenulum for an adult

The operation to trim the frenulum of the tongue can be performed at any age as prescribed by a doctor.

Every 20th person has a shortened frenulum of the tongue. The likelihood of this anomaly occurring in men is much higher than in women.

To independently check how the frenulum is located under the tongue, you can do simple children’s exercises: “horse”, “mushroom”, “painter”. Externally, the frenulum will not differ from a healthy state. If you experience any discomfort while performing these exercises, you should go to the clinic for a consultation.

Symptoms that will help you identify problems with tongue webbing:

When the tongue is extended, the tip of the tongue bends down;
Difficulty swallowing;
It is not possible to insert the tongue completely;
Bite problems;
Inflammation of the surrounding tissues of the tooth;
When the tongue is raised, it takes the shape of a heart;
Incorrect pronunciation of words.

Adults require frenulum trimming less often than small children. However, tissue healing in an adult takes a little longer than in small children. This type of operation is performed under local anesthesia.

When is surgery scheduled?

The frenulum circumcision operation is performed for the following indications:

Impaired pronunciation of words. If the speech therapist did not notice the deviation in childhood, then speech defects may occur in adulthood. The operation will help restore the functioning of the speech apparatus.
Orthodontist recommendations. A frenulum that is too short causes crooked teeth and stunts the growth of the lower jaw.
Periodontal recommendations. Due to deformation of the gums, the root of the tooth is exposed, which makes it susceptible to other diseases.

When not to have surgery

Since all surgical procedures have limitations. If you have:

acute chronic diseases of the oral cavity;
benign tumors of the jaw tissue;
infectious diseases of the whole body;
poor blood clotting;
mental disorder;

The operation to trim the frenulum of the tongue is called frenuloplasty.

Types of frenuloplasty

This type of operation can be performed in 3 ways:

Cutting. The bridle is trimmed, the edges of which are sewn with transverse seams.
Delete. The frenulum is trimmed using two triangular incisions and removed, after which sutures are applied.
Moving. The edge of the frenulum is trimmed and secured in the required place with sutures.

The entire operation takes no more than 20 minutes. After a few days, the stitches will dissolve on their own. There are no complications after frenuloplasty.

Why frenulum abnormalities require seeing a doctor

Abnormalities of the labial frenulum

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

Anomalies of the frenulum of the tongue

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

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

Preparation for plastic surgery

A medical examination is carried out, during which the degree of shortening of the frenulum of the penis and existing scar changes are revealed. The genitals are examined for the presence of rashes and skin changes, which are a contraindication to plastic surgery.

During the preoperative consultation, you should inform the urologist about the medications you are taking. Some medications have a negative effect on blood clotting and may be incompatible with anesthesia drugs. In this case, the medications are canceled or replaced with others.

The patient undergoes tests:

General – blood and urine.
Analysis for sexually transmitted infections, which are a contraindication to plastic surgery.
Blood test for coagulogram - clotting time and bleeding duration. If there is increased bleeding, surgery is contraindicated. Sometimes it can be done after preliminary normalization of blood counts.
Blood for the group and Rh factor is donated in case of unexpected blood loss, which is eliminated by the introduction of donor blood. If a man has documentary evidence of his group and rhesus, the study is not carried out.

Patients who are planning to undergo surgery under general anesthesia are prescribed an ECG and a consultation with an anesthesiologist - a doctor who will deal with pain management.

If necessary, other research methods and additional consultations with doctors may be prescribed.

One day before surgery, you should refrain from sexual activity, physical activity, and drinking drinks containing caffeine. You should not drink alcohol, as they are incompatible with pain medications and can cause bleeding. During the period of preparation for surgery, you should not take medications not recommended by your doctor.

Before plastic surgery of the frenulum of the foreskin of the penis, performed under general anesthesia, you should not eat for 8 hours. You can drink still water and unsweetened tea.

Pubic and groin hair is removed. Carrying out basic hygiene procedures is mandatory. Before the operation, you need to remove removable dentures, contact lenses, hearing aids, and empty your bladder.

At what age is it better to have frenuloplasty?

The sooner an anomaly in the shape and structure of the frenulum is identified, the more painless the operation to correct it will be. Accordingly, there will be many times fewer unpleasant consequences for the body.

infancy: this is the best option. The pathology is usually diagnosed in the maternity hospital during examination of the newborn. At the age of up to 9 months, the membrane of the tongue has not yet had time to acquire blood vessels and does not have nerve endings, which means that the procedure for its correction will be quick and painless. The baby will almost immediately begin to eat well and stop being capricious. In children who have undergone frenuloplasty before one year of age, their appetite is quickly restored, since the sucking reflex is not impaired,
1-3 years: this period is the best time to visit the dentist for the first time; he will be the one who will be able to diagnose the problem and take action. Trimming the frenulum at this age will also be quite painless and will not harm the jaw system,
5-8 years: if the pathology of the frenulum was not resolved at an earlier age, then this can be done when the baby teeth fall out, but it is better before the baby teeth are replaced with permanent ones. A specialist needs no more than ten minutes to eliminate the pathology. But it is worth noting that at this age the child can already speak, which means he will have to additionally visit a speech therapist to retrain the baby to pronounce a number of sounds.

Features of frenuloplasty

Plastic surgery of the frenulum of the penis is aimed at restoring the normal functioning of the organ. Performed for medical or reconstructive plastic purposes. During the surgical procedure, the doctor makes a transverse incision and then sutures the edges of the wound. The procedure lasts approximately 30 minutes and is often performed under local anesthesia. If the pathology is accompanied by phimosis, flesh circumcision is performed in parallel with frenuloplasty.

If sexual intercourse is accompanied by discomfort or unpleasant sensations in the frenulum area, a consultation with a urologist is recommended. Don't wait for the rupture to happen - it's painful and dangerous!

Stages of frenuloplasty

The procedure is quite simple and does not take much time. Using a scalpel or surgical scissors, the doctor will dissect the film. In children, this process does not even require pain relief; in older children, topical anesthesia is used. It is worth remembering that the older the child, the thicker the frenulum, so more time will be required for rehabilitation.

In the case of a short or long frenulum of the lip, the procedure will take more time. It must be performed under general anesthesia (deeper infiltration rather than superficial). If the frenulum is too bulky, the doctor will remove some of the tissue and apply stitches. If, on the contrary, it is short, dissection of the mucosa and even its partial transplantation will be required.

A few hours after the procedure, when the anesthesia wears off, pain and some discomfort are possible, but the edges of the wound are quickly covered with a thin film of epithelium, and the scar from the procedure disappears in a maximum of a couple of weeks.

Possible complications

Negative reactions of the body are possible after any external intervention. And cutting the bridle is no exception. Often after the procedure, the baby’s temperature rises and quite severe swelling appears.

Normally, these phenomena should disappear in about a day. If this does not happen, you should see a doctor again.

The following symptoms should also cause concern in parents:

persistent swelling of the tongue;
severe pain in the mouth;
the appearance of a gray-yellow coating or suppuration;
bleeding and suture dehiscence.

A light white coating in the sublingual area after the procedure is normal. It indicates proper growth of connective tissue.

Rules for rehabilitation after frenuloplasty

Many parents are interested in whether it is dangerous to have frenuloplasty. There can be only one answer here - it’s more dangerous not to do it at all. The procedure is very simple to perform, and there are almost never any complications after it. But, of course, as after any other operation, you need to follow some recommendations:

limit consumption of hot and cold foods,
Carry out oral hygiene with extreme caution,
follow the doctor’s orders and do language exercises to restore speech after the procedure,
visit a speech therapist to learn how to speak correctly.

These simple recommendations will help maintain health and very quickly return your child to a full life. But parents will definitely be required to monitor compliance with the rules.

1 Kozlova S.I. Hereditary syndromes and medical genetic counseling. Atlas-reference book, 1996.

Recommendations after frenulotomy

After the surgical procedure, the man remains in the clinic for several hours under the supervision of a doctor and a nurse. If he feels well, he can go home in two hours.

Important: the first few days after surgery, pain and discomfort in the penis area are detected - this is normal. To relieve pain, take painkillers - Ketanov, Ibuprofen.

To prevent the development of the inflammatory process, local antiseptic agents are used. For example, Levomekol ointment. If the wound surface does not heal for a long time, then drugs that accelerate the regeneration of the skin may be recommended.

Avoid any physical activity for two weeks;
Avoid intimacy for 2-4 weeks;
Refrain from masturbation until the penis is completely restored;
Regularly treat the wound with medications prescribed by the doctor;
Hygienic procedures are carried out using baby soap and boiled water. The use of other cosmetic products is strictly prohibited.

If a man wants to take a shower, then a condom must be put on the genitals to prevent the wound from getting wet. Up to 2 months after the intervention, you should use lubricants and lubricants during sex to prevent injury to the organ due to strong friction.

Contraindications for surgery

If there is a frenulum defect, the dentist or speech therapist will advise the most optimal period for the operation.

It depends on the age of the child, the presence of teeth and their health, malocclusion, as well as speech problems.

Correction of defects of the hyoid frenulum has a number of limitations and contraindications, including:

cancer;
hematological diseases;
infections;
inflammatory processes in the body;
untreated teeth and inflammation in the mouth.

Reasons for incorrect formation

Most often, a short frenulum of the tongue in children occurs if one of the parents or relatives had the same problem, that is, due to a hereditary factor and genetic predisposition.

At the same time, boys are more inclined to adopt this defect. The non-hereditary appearance of a short frenulum depends on the negative influence of unfavorable factors on the fetus in the first trimester of its development.

Reasons for this feature may include:

difficulties and pathologies during pregnancy (diseases or infections);
chronic diseases of the mother or childbirth after 35 years;
poor environmental situation in the place of residence;
abdominal injuries;
exposure to harmful drugs and substances (paints, varnishes, etc.);
exposure to drugs and antibiotics.

Anomaly or when dental assistance is appropriate

What should a normal frenulum be like? The length of the fold of the mucous membrane in the average person varies from 2.7 to 3.0 cm. It is located under the tongue in the central part and attaches it to the lower floor of the mouth. If the frenulum is located closer to the tip of the vocal organ, then it is called short. This anomaly limits the mobility of the tongue and causes rapid fatigue during eating and talking. In some cases, the length of the frenulum does not exceed 1.7 cm and does not cause discomfort.

How to determine the presence of an anomaly? It’s very simple, just touch the speech organ to the upper palate. If this action cannot be carried out, then it is time to contact the NovaDent dentist, and also find a good speech therapist in the Moscow region.

The operation is not considered difficult, and its price will be fully justified by a healthy future. Plastic surgery of the frenulum of the child’s tongue can be performed immediately after birth so that the baby can suckle normally at the mother’s breast. The surgical intervention takes about 5 minutes. The wound heals within 24 hours.

Symptoms

In order to determine the size of the child's frenulum, it is necessary to open his mouth, retract his lips and lift his tongue up.

Typically, the attachment point of the hyoid frenulum is located at an equal distance from the tip of the tongue and its root. Tongue with short frenulum:

bends in an arc (especially when trying to stick it forward);
has a curved tip that bifurcates and takes on a heart-shaped shape;
Makes clicking and clunking sounds when folded.

The frenulum may have a thick appearance or be a continuous fold attached to the sublingual space.

In addition, the frenulum may have an incorrect location and limit the free movement of the tip of the tongue upward or protruding it from the mouth.

Indications for surgery

Some pediatricians believe that a short frenulum of the upper lip is not an indication for emergency plastic surgery. But the indications for surgical intervention on the labial frenulum are determined not by a pediatrician or a dental surgeon, but by specialists of narrower profiles - a neonatologist, periodontist, orthodontist or speech therapist.

Often, a neonatologist pays attention to a problem with the frenulum in a newborn if this anomaly affects proper breastfeeding, because the baby’s upper lip is actively involved in this process. In this case, the doctor very often trims the frenulum of the upper lip on his own or may refer the child to a pediatric dentist-surgeon.

A short frenulum of the upper lip can be noticed by speech therapists if the baby’s clear speech functions are impaired and it is difficult to pronounce certain sounds that require the active participation of the lips, for example, “u”, “o” and others. Most often this happens in children after the age of five. In such a situation, conventional cutting is not enough; the patient needs a more complex operation.

Periodontologists and orthodontists most often refer children or adult patients for plastic surgery of the upper lip of a child or adult patient, since an incorrectly attached lip frenulum creates numerous negative consequences for the dental bite and periodontium. If plastic surgery of the upper lip frenulum is not carried out in a timely manner, this may lead to the need for lengthy and expensive orthodontic treatment in the future.