How to determine the frenulum of the tongue. How to check the frenulum under the tongue of a child? Short frenulum of the tongue: surgery

These small mucous strands can affect the clarity of speech, the aesthetics of a smile; in infants, the frenulum of the oral cavity can affect the quality of attachment to the breast, or the ability to suck a bottle. It is for this reason that parents should pay attention to these anatomical formations.

If the frenulum(s) of the oral cavity are short, the baby will not be able to eat properly, attach to the breast, and therefore will get tired faster, remaining hungry. There can be no talk of any increase in the child’s weight or height. Parents should remember and be aware of this problem and be able to notice alarming symptoms. According to statistics, a large percentage of short frenulums are registered in children, on average every 14 children. If the problem is diagnosed in time, it is possible to avoid those complications that can cause short frenulum.

Oral anatomy

There are three frenulums in the child’s mouth, and not alone, as many parents believe. After all, more " famous» frenulum of the tongue, which is attached to the underside of the tongue and sublingual space. The frenulum of the tongue is rightfully considered the most insidious, but at the same time practically the most important.

In addition to the frenulum of the tongue, in the baby’s mouth there are also frenulums of the upper and lower lips, which are also assigned certain functions. The frenulum on the upper lip should be woven into the upper lip and into the mucous membrane of the gums, just above the level of the front incisors. The frenulum on the lower lip is woven in the same way as the upper lip.

As a rule, a short frenulum in the mouth can be diagnosed in the parent department; this is more true for a short frenulum of the tongue. As for the rest of the frenulum of the oral cavity, diagnosis mainly occurs in the dentist's chair at a random appointment. There are cases when a tongue frenulum is not immediately diagnosed, and the frenulum in no way interferes with the feeding of the baby. But subsequently, the child may pronounce incorrectly defined sounds, and then the question of a short frenulum of the tongue comes up again, which, as a rule, is diagnosed at an appointment with a speech therapist.

Upper lip frenulum

When diagnosing a short frenulum, there are usually no difficulties, even for parents. To do this, you just need to carefully pull back the upper lip at rest and see at what level the mucous cord is attached. Normally, attachment should occur 5–8 mm from the neck of the child’s incisors. If the frenulum is attached lower or its attachment is not visible at all, then we can talk about a short frenulum.

What are the dangers of having a short frenulum?

In a newborn baby, a short frenulum on the upper lip can affect breastfeeding; the baby simply cannot position the upper lip correctly and correctly grasp the mother's breast. Only in this case can the frenulum of the upper lip be corrected in the maternity hospital. Fortunately, this happens quite rarely.
At an older age, a short frenulum in the oral cavity can affect the aesthetics of a smile, since a gap is formed between the child’s front teeth - a diastema (trema). Usually children are embarrassed by such diastemas, especially teenagers, and try to smile or talk less.

Such gaps between teeth are considered dental defects that require orthodontic treatment, sometimes in combination with surgery. But it is worth remembering that an aesthetic defect is not the only problem that can be caused by a short frenulum of the upper lip; the most serious complication is problems with bite, namely the protrusion of the front incisors forward.

The protrusion of the front incisors occurs as a result of pressure. The fact is that when talking or eating, the lips are involved, and the frenulum connects the lip and the alveolar process and pulls it along with it, while mechanically acting on the jaw in the area of ​​the incisors, promoting their advancement forward. The solution to this problem is orthodontic, and requires a fairly large investment of time and money. In fairness, it is worth noting that such a scenario can only develop in children with permanent incisors; if the baby still has a milk bite, then there is no need to worry.

Excessive tension of the gum mucosa can provoke inflammatory diseases in the area of ​​the front incisors - gingivitis, periodontitis. As a result, the child may develop increased tooth sensitivity. Speech defects may also be characteristic of a short frenulum; the toddler cannot correctly pronounce some sounds that the baby uses his lips to pronounce, for example, “o”, “u”, etc.

In addition, inflammatory diseases in the gum area can provoke caries in the neck area of ​​the teeth. Due to the low attachment of the frenulum, a large amount of plaque accumulates in the incisor area, and it is quite difficult to remove.

How does the correction happen?

Correction can be done exclusively surgically, but it is worth remembering some features. Correction of the frenulum on the upper lip is indicated only after or during the eruption of the permanent incisors! Usually this is 6 - 8 years old; until this age, parents should not worry.

It is not recommended to perform the operation before this period, with the only exception in the maternity hospital. Otherwise, such actions may result in bite pathology. A shortened and thick frenulum of the upper lip in a primary occlusion is not a pathology, but a variant of the norm; as the jaws grow, the frenulum can self-correct, i.e. stretch out and change its place of attachment.

It is for these reasons that the most optimal time for correction is the time when all the permanent incisors on the upper jaw have erupted, and active eruption of the canines begins, or when the anterior permanent incisors are erupting, and when the lateral incisors are actively erupting. The fact is that when the frenulum is corrected at this time, the erupting teeth will move the teeth towards each other and the gap between the teeth will close on their own, and there will be no need for orthodontic treatment.

If it was not possible to correct the frenulum in time, it is necessary to use orthodontic treatment, when the doctor places a “brace” on the front teeth, which will bring the incisors together.

Surgery

Dentists can use 3 types of surgical treatment:

Frenotomy - dissection;
Frenectomy - excision;
Frenuloplasty – relocation of the frenulum attachment site.

Children can cut the frenulum on their own, and cases of such injuries are quite common. For example, if you fall or chew toys too hard, the frenulum may rupture, which is accompanied by bleeding and hematoma. In case of injury, you must immediately contact your dentist for a solution. future fate injured frenulum. Frenectomy allows you to solve this problem, and even with trauma to the oral cavity, ruptures of the frenulum, as a rule, do not occur.

The operations themselves are performed in a surgical clinic, using local anesthesia, and the procedure usually does not take more than 30 minutes. After cutting the frenulum, the doctor places sutures made of a special biomaterial that dissolves on its own, which avoids the unpleasant procedure of removing them. The recovery period after the procedure is not long and takes from several hours to several days. And as soon as the swelling subsides after the operation, parents note that the child begins to pronounce sounds more clearly, or grasps the mother’s breast more freely.

The operation can be performed using various instruments - surgical scissors or a scalpel, or using a laser. Using the latter technique is the most acceptable, as it avoids stitches and significantly reduces the baby’s recovery time. Most often, the frenulum is corrected in young children using a scalpel, the amount of time spent is reduced, and immediate attachment to the chest is a prerequisite.

Frenum on the lower lip

There may be no frenulum of the lower lip or it may be forked. In order to diagnose a frenulum on the lower lip, it is necessary to retract the lower lip. At the same time, the frenulum itself becomes noticeable, which runs from the middle of the alveolar process of the lower jaw, intertwining below the area of ​​the lower incisors, and attaching to the lower lip.

Under normal conditions, the frenulum should be thin and almost invisible, in addition, it should be flush with the center line. If the baby's frenulum is thick, short and attached at the base of the lower incisors, the frenulum is short.

Why is a short frenulum of the lower lip dangerous?

By analogy with the frenulum on the upper jaw, the sucking function of a toddler may suffer. When sucking, the short frenulum pulls the lower lip along with it, thereby breaking the vacuum that is formed during sucking. The baby needs more effort, the baby quickly gets tired, remaining hungry and abandoning the breast. In this case, frenuloplasty can be performed in the maternity ward.

A short frenulum can also cause malocclusion, inflammatory and carious diseases in the area of ​​the lower front incisors. The formation of spaces between the lower anterior incisors is a rather rare phenomenon, but can still be diagnosed if the frenulum is woven into the area of ​​the gingival papilla between the anterior incisors of the lower jaw.

Treatment

The operation can be performed on children of different ages, but most often these are children with fully erupted permanent incisors. No less often, the frenulum can be cut already in adulthood, when it comes to prosthetics of the lower jaw.

The operation itself is carried out in a clinic, using local anesthesia, and 2 operations can be used to correct the frenulum - frenotomy, frenectomy.

Tongue frenulum

It is this frenulum that can influence the movement of the tongue; most often it limits these movements. The tongue is the most important organ in the oral cavity, which is involved in many functions - speech formation, nutrition, breastfeeding and much more.

Normally, the mucous cord is woven from the inside of the tongue approximately in the middle, and connects to the sublingual space. The normal length of the frenulum is about 8 mm. If a toddler’s frenulum is attached almost to the tip of the tongue, then this is a clear indication for correction.

This classic sign of a short frenulum of the tongue is not always found; there are other symptoms that can be used to diagnose its shortening. Doctors usually use a simple test that parents can use too. When the baby’s mouth is open, you need to ask her to touch the very roof of her mouth, and if the baby reaches without difficulty, everything is normal. But if a child experiences a painful reaction, or the child simply cannot perform this operation, this is a reason to contact a doctor.

The only drawback of this test is the age restrictions for children; such a test can only be performed on children over 3 years old. If the baby is younger, then he can simply refuse to carry out such manipulation. There is also a set of tests for younger children; doctors usually ask or provoke the child to show his tongue. And at the same time, the doctor evaluates how much the baby’s tongue can come out of the mouth.

Why is a short oral frenulum dangerous?

Every mother should pay attention to feeding the baby, monitor his reaction, pay attention to the sounds the baby makes, and weight gain. With a short frenulum of the tongue, the baby simply cannot properly place his tongue under the mother’s nipple, it turns out that the baby cannot grasp the breast correctly, and “clicking” sounds may occur during feeding.

In addition to inadequate breastfeeding and problems for the mother, the baby spends more effort to get enough, the baby's sucking activity gradually decreases, and the feeding time itself increases, during which the baby takes a short break. The baby tries to compensate for the greater amount of effort by clenching his jaws, and often when feeding, babies bite their mother's breast.

Often such children set their own feeding schedule, since complete saturation occurs within large quantity time, babies usually eat about every two hours. Weight gain is at the lower limit of normal, or even lags behind.

The frenulum may not be diagnosed in infancy, and can be detected during the period when the baby begins to actively talk. Babies with a short frenulum of the tongue cannot correctly pronounce quite a lot of sounds, namely those sounds in which the tongue should touch the palate or upper incisors - “r”, “sh”, “sch”, “ch”, “ry”, etc. Diagnosis of the frenulum often occurs at an appointment with a speech therapist, from where parents receive a referral to a dentist.

Treatment

Treatment can take place in two ways - surgical or speech therapy; often a combination of these two methods occurs. Parents should remember that the choice of treatment method lies entirely on the shoulders of the dentist, and not the speech therapist.

Surgical correction of the frenulum

The frenulum can be corrected in the maternity hospital, the operation is carried out in the obligatory presence of the mother, and after the operation the baby must be immediately applied to the breast. There are no nerve endings in the frenulum itself, but there are blood vessels; there are none in the place where the dissection occurs, therefore, there is no pain or bleeding. Babies can simply get scared, and applying to the breast is more of a calming maneuver.

In young children, correction is most often carried out using a laser, which eliminates the need for stitches and reduces recovery time.

In older children, namely school children, it is performed under local anesthesia. In this case, the doctor cuts the frenulum and applies sutures using a classic set of instruments. It is more advisable to use a laser scalpel. When using it, the time of the operation itself is reduced, and there is no need for sutures.

After rehabilitation, the baby must follow a special gentle diet and perform the exercises recommended by the dentist or speech therapist. These exercises are aimed at training the frenulum. If the frenulum is not very shortened, then it is possible to solve the problem without surgery, but only if the child is less than 5 years old.

Speech therapy exercises

Exercises can be different, and the choice will depend on the age of the child. For the little ones we can offer game exercises, where the baby’s tongue will be involved, for example, the “kitten” exercise - the baby is asked to lick the saucer like a kitten.

You can use the exercise " horse", ask the baby to click like a horse, while the tongue rises to the sky, tension and stretching of the frenulum occurs, which trains it.

At the appointment, the speech therapist can massage the frenulum using special tools or with the help of hands. It is worth remembering that the child gets tired quite quickly, and unpleasant sensations, even pain, may occur. That is why the load must be increased gradually, and it is precisely this fact that is associated with the fact that speech therapy treatment does not give quick results, and in most cases it is impossible to do without surgical intervention. And when diagnosing a short frenulum, it is necessary to obtain

The hyoid frenulum is a thin bridge that is the connecting link between the tongue and the lower oral cavity. It should reach the middle of the tongue, but in newborn children there is also a short frenulum, which can be attached at the very tip of the tongue or practically absent (then the tongue is almost not separated from the lower oral cavity). In the photo you can see what a normal frenulum looks like.

Bite, diction and dental health depend on the correct structure of this small organ. If the problem exists from birth, it manifests itself in infancy as improper sucking and poor quality breastfeeding.

The frenulum connects the tongue to the lower part of the mouth and is an important factor in the quality of articulation

Why is the hyoid frenulum short?

A short frenulum of the tongue is scientifically called ankyloglossia. Scientists have not yet established exactly why such a developmental deviation occurs. Now only a few of the most probable reasons are named:

1. The biggest factor in this case is hereditary. If the mother or father was diagnosed with a short frenulum, then the child’s probability increases to 50%.
2. Violation of the formation of the sublingual septum can provoke toxicosis in the early stages of the mother's pregnancy or viral and acute respiratory diseases. Treatment with medications, especially hormones and antibiotics, plays an important role here.
3. Injuries to the mother's abdomen during pregnancy can affect the development of the child.
4. Another reason is late pregnancy. Older mothers (after 35 years) may have children with a tongue frenulum that is too short.
5. Impact chemical substances in any form - for example, work in conditions of high toxicity, contaminated environment, bad habits (smoking, alcoholism, drug addiction).
6. Of great importance for the full development of the baby is emotional condition mothers during pregnancy. Frequent stress can also affect the formation of the hyoid frenulum.

Signs

What is the norm? In a newborn child - 8 mm (maybe longer, but not shorter). By the age of 5 – up to 17 mm. The free tip of the tongue should be 16 mm long at one and a half years. A speech therapist can determine the pathology.

A speech therapist will be able to diagnose pathology in older children - a visit to a specialist will not be superfluous

To find out whether your baby’s hyoid septum is developing correctly, it will be problematic to use any measuring instruments. However, there are various external signs by which you can notice deviations.

Short frenulum in a newborn:

• feedings occur frequently and last a long time, while the baby stops to rest;
• when you give the baby the breast, he behaves restlessly - cries, arches;
• the baby is not gaining weight well;
• the child bites the breast when feeding;
• while eating, the baby “clacks” and clicks his tongue;
• there is a high risk that he will completely give up breastfeeding.

In older children and adults:

• bite defects;
• periodontitis;
• difficulties in fixing implants and prostheses;
• incorrect reproduction of hissing sounds, as well as “r”, “l”, “d”, “t”.

Various defects in the structure of the oral cavity can also confirm these fears:

• the lower incisors are turned inward;
• the tip of the tongue is divided in two; when pulled out, a depression is noticeable on it;
• it is impossible to touch the palate, lips or stick it out with the tongue;
• the back of the tongue is raised, and the middle is pressed downwards, which is why the tongue looks humpbacked;
• To swallow chewed solid food, you need to move it to the back of the tongue.

With a normal bite, the child is able to stick out his tongue, and at an older age, at the request of the parents, he can reach the palate or upper lip

How is the functionality of a language determined?

You can determine the length of the jumper special test. According to indicators, developmental anomalies can be of varying degrees:

• light – a frenulum more than 15 mm long, disturbances in the pronunciation of sounds are observed;
• medium – frenulum length less than 15 mm, all signs are present;
• heavy – length up to 10 mm if all signs are present.

Test suggested American professor Alison Haselbaker in Tongue-Tie. When determining the length, it takes into account how appearance, and the functionality of the jumper. She also lists the parameters that normal development must meet:

1. You need to place your finger on the lower lip in the center and move it from one side of the mouth to the other. In this case, the tongue should easily move behind the finger.
2. The child needs to lift the tip of the tongue towards the upper palate. There should be no difficulty in performing this action.
3. Place your finger on your lower lip and move it to your baby's chin. The tongue should follow the finger and freely touch the lower lip.
4. Press the pad of your finger against the upper palate. When sucking, the tongue will be smooth and should contract from the tip to the roof of the mouth.
5. Touch your fingertip to your upper palate. The tongue should not snap off.
6. Ask your baby to lift his tongue (see also:). In this position it should take on a round or square shape.
7. Invite your child to press the tongue down. If development proceeds normally, he will do this without difficulty.
8. The baby needs to lift his tongue. The length of the frenulum should be more than 1 cm.

Deviation even in some of the listed parameters is considered an alarming signal. It is important to know that correction should be addressed at a very early stage, since moderate and severe degrees will require much more effort and entail additional problems.

Using the developed test program, parents themselves can determine the functionality of the child’s language

Kinds

The short bridle is divided into 5 varieties:

1. Thin, transparent. The functionality of the language is only slightly restrained.
2. Thin, translucent. If you lift your tongue, its tip bifurcates.
3. Thick, opaque. If you push your tongue forward, the back will be raised and the tip will be tucked in.
4. Short. The bridge fuses with the muscles of the tongue.
5. Practically absent. Interweaving with the muscles of the tongue is observed.

Medical consultation

The problem of ankyloglossia is dealt with by a dentist and an orthopedist. If you notice any deviations, contact a specialist. He will accurately diagnose the degree of anomaly and give the necessary recommendations. This may be surgery or non-surgical measures.

Undoubtedly, correction of the deviation needs to be done. The sooner you start this, the bigger problems you can avoid:

1. For an infant, feeding becomes problematic. The baby does not latch onto the breast correctly, is unable to suck well, makes different sounds with his tongue when feeding, gets tired and stops to rest. However, the child still remains hungry, becomes restless, and practically does not gain weight. As a result, the mother produces less milk and there is a great risk that it will completely disappear and natural nutrition will have to be replaced with an artificial formula.
2. With a short frenulum of the tongue, the bite will be formed with disturbances. Because of this, speech function is significantly impaired and speech defects will certainly appear.
3. When the child has teeth and moves to the common table, difficulties will arise when chewing and swallowing solid food. Plus, indigestion, belching, diarrhea, periodontitis, gingivitis.
4. The functioning of the respiratory system is disrupted. Because of this, sleep suffers and apnea occurs (short-term cessation of breathing). Mouth breathing begins to predominate, and this, in turn, leads to frequent colds.
5. The influence of ankyloglossia on the formation of posture has been scientifically proven. Be prepared for spinal curvature.

What does the famous children's doctor Evgeniy Komarovsky say about the problem? He divides the consequences of this deviation into 2 groups: sucking and speech. When a pediatrician identifies abnormal frenulum formation in a newborn, it is up to him to decide on the need for surgical intervention. At older ages, correction is carried out by a speech therapist.

Surgical intervention

A short bridle can be trimmed. This is a very common way to solve the problem, and often even the only one. Before agreeing or refusing, you need to know how justified it is, what contraindications it has and how this process is carried out in general. Plus, the operation can be performed in different ways.

Indications

There are cases when surgery is indispensable:

• critical situation with natural feeding;
• improperly formed bite;
• tooth displacement;
• speech defects that cannot be resolved conservatively.

To confirm the need for surgery, an examination by a surgeon, speech therapist and orthopedist is needed. Only if the situation is hopeless will this decision be justified.

Contraindications

Surgical intervention for a short frenulum of the tongue is prohibited when any of the diagnoses is confirmed:

• malignant tumors;
• blood diseases;
• any infection in the mouth or body;
• stomatitis.

Before the operation is scheduled, the baby’s oral cavity must be examined for infectious lesions and stomatitis.

As before any operation, it is necessary to undergo a full examination. If no prohibiting factors are identified, surgical intervention is permissible.

Types of operations

There are 3 types of operations. They differ in the way they are carried out:

1. Frenulotomy. This is the simplest operation. The sublingual septum is cut with scissors at a distance of 1/3 of the length of the bridge closer to the lower teeth. First, the mucous membrane is dissected, and then the cords. Then the edges of the mucosa are brought together and a suture is placed every 3-4 mm.
2. Frenulectomy (Glickman method). The frenulum is fixed with a clamp, after which incisions are made between the clamp, the lip and the mucous membrane on the side of the teeth. Then a suture is applied.
3. Frenuloplasty (Vinogradova method). Two converging incisions are made from the transitional fold to the interdental papilla. A triangle-shaped flap is separated, and the edges of the wound are sutured. After this, the triangle is sewn to the remaining wound surface.

Less common techniques include Limberg and Popovich frenuloplasty. The short frenulum of the lip is trimmed in the same way. This operation is performed in case of orthopedic and orthodontic diseases.

Any of the operations involves making an incision on the frenulum of the tongue

How is the operation performed?

If a short frenulum was discovered in a child in the first days of life, the operation is performed in the maternity hospital. Frenulotomy can be performed until the baby is 10 months old. In this case, local anesthesia is used. In such a short period of time, the jumper has not yet become overgrown with nerve endings and blood vessels, so the operation is painless and without blood. Once completed, the baby should be placed at the breast and the healing process will only last a few hours.

For older children, the operation is also performed under local anesthesia, but in a clinic. This procedure lasts only 5-10 minutes. Bleeding during incisions is prevented with an electrocoagulator or electric scissors. It will take 1 day for the wound to heal.

For several days after surgery, it is recommended to limit the consumption of hot and solid foods, as well as carefully maintain oral hygiene. In special cases, frenuloplasty is required.

As practice shows, if the operation to trim the short frenulum was performed no later than 9 months, the child will not have speech defects. In addition, after surgery, babies begin to eat better. Older children will need to work with a speech therapist and do exercises to stretch the hyoid bridge so that it does not fuse again. You will also have to work on the pronunciation of sounds.

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:

• 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.

Not complicated speech therapy exercises will help consolidate the postoperative result and develop good diction

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 clamped 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.

Dear parents, today we will talk about how to identify a short frenulum of the tongue in a baby. In this article you will learn what main signs can be used to suspect such a condition, why this happens, and what treatment methods are available. You will know what age is considered optimal for the surgical procedure, as well as what contraindications exist for such therapy.

Short frenulum - what is it?

Upon visual inspection, this formation resembles a thin membrane represented by connective tissue. The main function is to attach the tongue to the oral cavity (lower part). A tongue tie in a child is a condition that makes it difficult for the fleshy organ to move.

It can be congenital and hereditary. Partial and full forms are considered. When complete, the formation of muscles (cords) is observed, the tongue is virtually immobilized, and pronunciation is very poor. Partial - connective tissue is replaced by muscle cords.

There are three degrees of functional limitation of the fleshy organ:

• light - size greater than 15 mm, there is a violation in sound pronunciation;
• medium - frenulum from 10 to 15 mm, accompanied by impaired pronunciation, inability to reach the palate with the tongue;
• severe - length up to 10 mm, the baby is not able to lick his lips, cannot pronounce sounds correctly, touch the palate with his tongue, or stick out his tongue.

Possible reasons

Hereditary factor is a possible cause of short frenulum in a child

There are a number of factors that influence the formation of frenulum shortening:

• heredity;
• bad ecology;
• infection of the fetus during gestation;
• injury to the pregnant woman's abdomen;
• factors of unknown etiology;
• infectious processes in the body of the expectant mother;
• woman's age over 35 years.

Symptoms

The formation of malocclusion can be observed due to a short frenulum

Characteristic signs of the presence of a short frenulum include:

• increased salivation;
• digestive problems;
• difficulty chewing solid food;
• a quiet voice with a nasal tone;
• frequent;
• malocclusion;
• gum recession;
• periodontitis;
• dyslalia (organic type);
• The incisors on the lower jaw tilt inward.

Signs in infants

Difficulty sucking the breast may be the first alarming symptom

The following symptoms may indicate that your little one has a short frenulum:

• the baby bites the breast while sucking;
• smacking when feeding;
• prolonged act of sucking;
• frequent feeling of hunger;
• capriciousness when feeding.

Home diagnostic method

To determine whether a baby has a short or long frenulum, you need to ask him to perform certain actions.

1. Let the little one stick out his tongue at you. If the frenulum is short, it will be difficult for the child to remove it completely from the mouth or the edge of the tongue will be tilted down.
2. Let your baby raise his tongue to the roof of his mouth. If there is a deviation, the child will either not reach at all or will climb sides language, the central one is practically inactive.

In addition, you can visually determine whether the frenulum is normal or not. So, normally, a newborn toddler’s frenulum is longer than 8 mm, and a five-year-old child’s frenulum is longer than 17 mm.

Where to contact

If you are interested in the question of where to trim a child’s tongue frenulum, then the answer is simple - in a dental clinic. The procedure will be carried out by a surgeon, but before you decide to take this step, you will need to consult with several specialists:

• from a pediatrician - for problems with eating;
• see a speech therapist if there are difficulties in pronunciation;
• at the orthodontist - if malocclusion develops.

Treatment

Classes with a speech therapist -
an effective method for mild cases of short frenulum

Therapy can be either medicinal or non-medicinal. Everything will depend on the severity of the child’s condition.

Non-drug methods include:

• massage;
• classes with a speech therapist;
• correction exercises;
• articulation gymnastics.

Drug therapy involves surgery. It can be of varying degrees:

• easy - will be carried out directly at the appointment and without anesthesia in cases where the sublingual membrane is plastic and very thin;
• frenulotomy - will be performed on a child with a thick frenulum under local anesthesia, stitches will be placed.

You need to know that the operation can be complicated:

• prolonged bleeding;
• wound infection.

Exercises for correction

Exercise in front of a mirror

1. Ask your child to stick out his tongue and try to touch the tip of his nose, then his chin. Take a break and do another approach. At first, the exercise should be repeated no more than five times, over time it is increased to 20.
2. Let the baby stick out his tongue and begin to move it left and right. Initially five approaches, increased to 20.
3. We ask the little one to open his mouth wide. Let him touch the tip of his tongue to the upper incisors and try to press on the teeth with all his strength. It is important that your mouth remains open. Each time the child must count to ten (to himself). We also start small and work up to 20.
4. We spend it in front of the mirror. Let the little one open his mouth wide and follow the movements of his tongue when pronouncing the syllables “kar - kar - kar”, “bar - bar - bar”.
5. Ask your child to lick his lips, first the top, then the bottom.
6. Let the baby close his mouth and move his tongue in one direction or the other. With all his might he presses on the inside of his cheeks with the tip of his tongue.
7. To achieve a good and quick effect, you need to do the exercise daily for 15 minutes.
8. If correction is prescribed after surgery, it begins only after the wound has healed.

Operation

The procedure is performed under local anesthesia.

An operation is prescribed if the severity is severe; in the case of moderate severity, the doctor makes the decision; in mild cases, treatment is carried out using conservative methods, in particular, speech therapy and sessions with a speech therapist.

Indications for surgical intervention will be:

• severe limitation in tongue mobility;
• moderate severity of the disease in the absence of positive results from therapeutic treatment;
• lack of monthly weight gain;
• development of malocclusion;
• inability to latch onto the nipple during feeding;
• the process of formation of displaced dentition;
• the need to install dentures, including removable ones.

It is worth considering that the operation may have certain contraindications. These include:

• infectious processes in the oral cavity;
• oncology;
• blood diseases;
• gingivitis;
• acute infectious process in the body.

Depending on the age, the child may be prescribed one of three types of surgery:

• frenulotomy (can be performed on children up to nine months old) - an incision is made with scissors closer to the teeth, the mucous membrane is initially dissected, then the muscle cords are applied, sutures are applied;
• frenulectomy (performed on a child over five years old) - the septum is fixed with a clamp, an incision is made between it and the lip, and stitches are applied;
• frenuloplasty (applicable for children over five years old) - a triangular flap is truncated from the bridge, then an incision is made and this flap is sewn in the right place to lengthen the frenulum.

My son had his bridle cut when he was 7 months old. I was not present at the procedure, I was very worried. Dad and grandmother went with him. Everything went without complications, and the child recovered quickly.

Laser treatment

Laser method of surgery

IN last years They are increasingly using the method of cutting the frenulum using a laser. This method has a number of advantages:

• practically painless;
• there is no need for stitches;
• the cut is made accurately;
• wounds heal quickly;
• minimum consequences or their complete absence;
• disinfecting properties prevent infection;
• no bleeding during surgery.

Optimal age

The sooner the operation is performed, the less painful it will be for the child.

If you are wondering at what age a child’s tongue frenulum is cut - if it is detected early in the first month of life, while still in the maternity hospital. The best time The first year of a baby's life is considered. However, there are often cases when parents do not notice the problem, and realize that something has gone wrong when problems with pronunciation arise at the age of five. At this time, a longer operation will be performed under anesthesia.

Now you know how the procedure is carried out. Remember that the lack of timely treatment can lead to speech problems and the development of pathology. No matter how sorry you feel for the baby, if there is an urgent need, go for surgery.

Such anatomical formations are the thinnest folds of the mucous membrane that connect the mobile lips and tongue with the fixed parts of the oral cavity: the gums and the sublingual space.

In total, there are three frenulums in the baby’s mouth:

1. Tongue - located under the tongue.
2. Upper lip - localized between the upper lip and the gum mucosa above the level of the central incisors.
3. Lower lip - connects the inner surface of the lower lip with the gums at the level of the middle of the alveolar process on the lower jaw.

Despite their small size, such mucous folds have great importance In human life. In a newborn, they are responsible for proper attachment to the mother's nipple. In older children, the frenulum is involved in the correct pronunciation of sounds and in the formation of a normal bite.

In the photo: a short frenulum of the tongue in a child

Short frenulum and why it is dangerous

Shortening of the frenulum is understood as a decrease in its absolute length or its incorrect location, which makes it relatively short (i.e., the length remains normal, but its incorrect localization causes all the symptoms characteristic of shortening).

A short frenulum of the upper or lower lip in a baby can negatively affect the process of breastfeeding. In this case, the child cannot correctly position the nipple in the oral cavity and create a sufficient vacuum necessary for sucking and swallowing. Therefore, in order to get enough, the baby has to make significant efforts. The baby quickly gets tired and stops breastfeeding without being properly satisfied. Such children behave restlessly, require frequent breastfeeding, but do not gain weight well.

In children over 3 years old, a shortened upper frenulum can cause an increase in the interdental spaces between the upper incisors and their advancement sharply anteriorly. A short lower labial frenulum sometimes causes malocclusion.

Also, a decrease in size or incorrect location of any of them can have an extremely negative impact on speech function. Children 2 years of age who have not had this pathology diagnosed or corrected in time often do not pronounce individual sounds. Such speech defects are difficult to correct.

How to check a child's frenulum?

A shortened frenulum between the lip and gum is diagnosed quite simply even in infants. To do this, you need to carefully pull back the child’s lips and see how pronounced the fold of the mucous membrane is and where it is attached. If it is short, then it will have a thick appearance and its attachment point will be at the very base of the incisors.

The hyoid frenulum normally has a length of at least 8 mm and is attached approximately halfway between the root and tip of the tongue. A small frenulum usually looks like a fold on the mucous membrane, attached along its entire length to the tongue or sublingual space.

In the photo: a short frenulum of the upper lip in a newborn

How to stretch

It is necessary to immediately make a reservation that, due to anatomical features, only the frenulum under the tongue can be stretched without surgery. This technique is usually taught by a speech therapist and is effective only if all recommendations are carefully followed over the course of several months.

Before performing any exercises, it is recommended to do a special massage to stretch the soft tissues. To do this, you need to carefully take your tongue by the very tip and with gentle movements move it upward, then to the sides and pull it forward a little. Gentle stroking from bottom to top along the frenulum using the thumb and index finger has a good effect.

The exercises themselves are performed sequentially twice a day:

1. Relax your tongue as much as possible and place it on your lower lip. Hold for 10 seconds in 3 sets.
2. Stick your tongue out of your mouth as far as possible. Fix in this position for 10 seconds. Repeat 3 times.
3. Extend your tongue and circle your lips with it.
4. Click your tongue for 10 seconds, imitating the clatter of horse hooves.
5. Open your mouth wide. Slowly run the tip of your tongue across the roof of your mouth, moving from your teeth to your throat.
6. Place your tongue on the roof of your mouth just behind your teeth. Holding it in this position, open your mouth as wide as possible.

Such fairly simple exercises help both stretch the frenulum on the tongue and correct some speech defects.

Surgical correction

If a short frenulum is detected in the maternity hospital, then its trimming is carried out immediately. This is done so that the baby can properly take the nipple and eat properly. If shortening is diagnosed at an older age and is not corrected by speech therapy techniques, then three options for surgical treatment are possible:

• Frenotomy is cutting to increase its length.
• Frenectomy is a circumcision when it is almost completely excised.
• Frenuloplasty is a plastic surgery during which the place of its attachment in the mouth is changed.

In the photo: a child’s tongue frenulum after laser surgery

Despite the fact that frenulum surgery itself is quite common, most parents have a lot of questions about this procedure. We will consider the main ones below.

Why trim?

A too small size of such a fold of the mucous membrane can cause difficulty sucking at the breast in infants, and problems with the pronunciation of certain sounds and with the arrangement of teeth in the permanent dentition in older children. To avoid such problems, pruning is required.

Do I need to prune?

Most doctors, including the famous Dr. Komarovsky, are of the opinion that a short frenulum should be trimmed if it adversely affects the child’s ability to suck milk or pronounce certain sounds.

When a short frenulum does not negatively affect the processes of sound production and bite formation, then in such cases surgical intervention is not required.

What kind of doctor cuts?

Typically, frenulum correction operations are the responsibility of a dentist.

At what age is it best to have surgery?

When the frenulum should be trimmed is decided individually for each child. If we're talking about about a fold on the upper lip, then correction is done no earlier than 6 years. Typically, the operation is performed only after the eruption of the permanent upper incisors. If correction is required on the lower lip, this is done more often after the 4th year of life.

In most cases, the hyoid frenulum is cut before 1 year of age (most often this is done in the maternity hospital). But correction is possible at any age.

How do they prune?

The frenulum trimming operation is performed on an outpatient basis in the surgical office of a dental clinic. The doctor carefully stretches the fold of the mucous membrane and makes a small incision with a sharp scalpel. After that, small sutures made of threads are applied to the edges, which after some time dissolve on their own and do not need to be removed.

A more modern technique is laser dissection, which eliminates the need for stitches, which speeds up the child’s recovery process.

Does it hurt to prune?

The dissection procedure is performed under local anesthesia, which eliminates the possibility of any pain.

What to do if a child breaks the frenulum

Children at any age are quite active and mobile. Therefore, injuries are inevitable. Quite often, parents turn to the dentist with the following problem: the baby fell unsuccessfully and tore the frenulum above the upper lip or under the tongue. At the same time, damage to the lower lip is extremely rare due to the fact that normally it is almost not expressed.

If a child cuts the frenulum, then the following signs will be characteristic of such an injury:

• Swelling of the soft tissues in the mouth and above the lip (if the child has torn the upper lip).
• Quite profuse bleeding.
• Pain in the mouth when talking or eating.

In any case, if the baby has torn the mucous fold under the upper lip or under the tongue, you should immediately consult a doctor. It is he who will decide whether such a gap needs to be sutured and will carry out the necessary procedures. Self-treatment may lead to negative consequences: the tissues grow together incorrectly with the formation of rough scars, which will subsequently lead to an incorrect bite and unclear pronunciation of sounds.

A short frenulum is a common diagnosis in babies, which a mother can hear even in the maternity hospital. There, this pathology must be immediately eliminated, because the newborn baby will have difficulty sucking the mother’s breast or feeding from a bottle. The frenulum can be successfully corrected, the procedure is quick, almost painless and well tolerated, so don’t worry if this happens to your baby. This is a common operation in the practice of pediatric surgeons. Much more dangerous are the consequences that this anomaly can cause in advanced cases.

An abnormally short frenulum occurs in many newborns, but if surgical intervention is performed in time, the child will not remember this problem in the future

Why does a child have a bridle cut, and is it really necessary?

The frenulum of the tongue is a membranous bridge that connects the tongue and the lower jaw (see also:). Thanks to its presence, the tongue is held in its normal position. It is responsible for many important functions in the human body:

• feeding, in infancy - breast sucking;
• correct pronunciation;
• normal bite;
• work of facial muscles.

When the frenulum has developmental pathologies, the normal functioning of the oral cavity is disrupted. Normally, it is located in the middle of the tongue and has a length of about 2.5-3 cm; in babies under one year old it is 8 mm. Typically, abnormalities of the frenulum consist of shortening the length or attaching it to the tip of the tongue. This deviation is called ankyloglossia, or short frenulum. The location of the frenulum in the mouth, characteristic of this anomaly, is shown in the photo.

How is ankyloglossia dangerous for a baby? It causes abnormalities in jaw development and malocclusion. You can understand that a baby has a short frenulum immediately after birth. The baby sucks poorly, gets tired quickly, cries and often latches on to the mother’s breast. During feeding, characteristic clicking sounds are heard, and milk pours out of the mouth. Such children grow slowly and gain weight, because their tongue is inactive, and sucking causes discomfort; it hurts to move the tongue. The same thing is observed in artificial babies.

At an older age, a simple test is used to determine ankyloglossia: if the child can reach the upper palate with the tip of the tongue, the length of the frenulum is normal. A specialist may suspect a deviation when a child has malocclusion, periodontitis, speech therapy pathologies, discomfort when chewing and swallowing food. Typically, this problem is diagnosed by a speech therapist, who is consulted for help with incorrect pronunciation of sounds and words.

Ankyloglossia must be treated, otherwise it leads to serious disorders:

• chewing food;
• bite;
• pronunciation;
• nasality;
• snoring (apnea);
• inflammatory diseases of the oral cavity;
• frequent colds due to mouth breathing;
• disorders of the gastrointestinal tract;
• scoliosis.

Ankyloglossia often occurs for hereditary reasons. If relatives had such a pathology, the likelihood of having a child with the same disorder is quite high. In addition to genetic predisposition, a short frenulum is formed due to pathologies of the mother’s pregnancy and other factors:

• viral diseases (the first and third trimesters are especially dangerous);
• toxicosis;
• exacerbation of chronic diseases;
• psychotraumatic situations;
• taking alcohol, drugs, chemical poisoning in the first 3 months of pregnancy;
• poor environmental situation in the region of residence;
• abdominal bruise or other injuries.

At what age is this surgery performed?

There are no age restrictions for plastic surgery; it is performed on both the youngest patients and children school age, and adults. The mother is practically never separated from the child, because the frenuloplasty itself takes place quickly.

Plastic surgery of the lingual frenulum is easier to tolerate in the first months of life. It is best done for a newborn so that the baby can eat comfortably and grow well.

In older children, the correction is more difficult, since it is performed under general anesthesia, and convincing a one-year-old child to sit quietly for a few minutes is much more difficult than operating on an infant. That is why doctors recommend in some cases to delay intervention until the age of 4-5 years.

However, during this time, persistent speech disorders may appear, which will subsequently require long-term correctional work and constant exercises. Other experts recommend trimming the membrane between the tongue and jaw while the upper teeth are growing.

Where is frenuloplasty performed and which doctor should I contact?

If ankyloglossia is suspected, the child will be referred for consultation to a dentist, orthodontist or maxillofacial surgeon, who will confirm or refute the preliminary diagnosis. The decision about the need for surgical intervention will be made jointly by the orthopedist, surgeon and speech therapist.

3 degrees of pathology: mild, moderate and severe

There must be good reasons for this:

• serious nutritional problems in a newborn baby;
• speech therapy disorders that cannot be corrected by conventional means;
• malocclusion;
• violation of proper food intake;
• displacement of teeth, incisor inclination.

Experts divide the degree of pathology on a 5-point scale. Minor deviations can be successfully eliminated without surgery after the age of 1 year by performing special exercises.

The operation is performed in a maternity hospital or in dental clinics for older children. If the case is complex, they operate in the maxillofacial departments.

Surgical correction of a short frenulum

A newborn baby can undergo surgery in the maternity hospital, because at birth the neonatologist will check him for the presence of this pathology. In older children, the procedure is carried out quickly, it does not require a hospital stay, and after it you can go home straight away.

Contraindications to cutting the frenulum may be:

• oncological diseases (including oral cavity);
• blood diseases;
• acute infectious diseases;
• diseases of the oral cavity and teeth (caries, pulpitis, osteomyelitis).

Trimming of the frenulum is carried out if the child is completely healthy; If there is caries or other disease, surgery is not possible

Main types of operations for ankyloglossia

The decision about what type of surgical intervention will be appropriate is made by a specialist. Usually this:

• frenulotomy - cutting the frenulum and suturing the edges of the mucosa;
• frenulectomy, or the Glickman method, when the frenulum is cut from the side of the teeth;
• frenuloplasty, or Vinogradova’s method, in which a layer of tissue is cut from the mucosa and sutured to the frenulum.

There are other ways - it all depends on the specific case. The specialist will advise how best to proceed in this situation; perhaps, cutting the frenulum will not be necessary.

How is the frenulum trimming procedure performed?

A child over 2 years old needs to be explained why the bridge between the tongue and jaw needs to be cut. It is necessary to calm him down so as not to cause severe stress.

The operation is performed under local anesthesia. A newborn baby does not yet have nerve endings or blood vessels in the frenulum. That is why pruning it does not cause much concern for the baby and parents. The operation time usually takes 5-10 minutes.

For an older child, a lidocaine spray or gel is applied to the site of the future incision. The doctor then trims with a surgical scalpel or scissors. Sutures are not always required.

Laser treatment

Laser correction is considered the safest method of surgery and is classified as microsurgery. It causes virtually no complications. Sutures are not applied after laser surgery, this is not necessary, and the postoperative period lasts 2 days.

The duration of the laser operation is only 3-5 minutes. This method is suitable for children because it does not cause bleeding or complications in the form of secondary infections, it is accurate and practically painless.

Rehabilitation period

For babies under 9 months, the rehabilitation time is only a few hours, after which the baby can be put to the breast. In older children, the recovery period lasts about a day. After laser surgery, recovery is even faster.

Immediately after the operation, babies begin to eat normally without experiencing discomfort, and breast milk will help the wound in the mouth heal faster. Breasts quickly gain weight and grow well. Speech therapy disorders in babies under one year of age are not diagnosed, but older children will need correctional work with a speech therapist. What exercises are recommended to be carried out in the presence of pathology can be seen in the video.

If pathology is present, it is recommended to regularly perform simple exercises

After frenuloplasty you should:

• do not eat for 2 hours;
• Do not eat irritating foods for 3-4 days - salty, spicy, sour and too hard;
• refuse hot food and drink;
• For some time it is better to eat food pureed;
• do not load your tongue with conversation;
• after eating, you must rinse your mouth with antiseptic agents (chamomile decoction, calendula tincture, Furacilin solution);
• do special exercises developed by your doctor;
• apply sea buckthorn oil and Solcoseryl to the surgical site;
• visit a speech therapist as prescribed by the attending physician;
• if there is pain, the child is given an anesthetic (Nurofen, Ibuprofen).

Are there complications after surgery?

Usually, there are no consequences other than short-term restoration of normal function of the oral cavity and tongue. Everything goes quickly, almost painlessly and is well tolerated by the child.

If postoperative wound treatment is poor or hygiene is poor, inflammation and pain may occur. School-age children sometimes develop scars, in which case repeated incision will be required.