Frenectomy

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Frenectomy is a scary sounding word for a fairly simple and common procedure that addresses a few different medical problems, usually in the mouth and in children. The word frenum, or frenulum, describes the tough tissue that attaches any organ to the its neighboring tissue to prevent it from moving too much. Think of it as a kind of tether to limit movement. There a several frenums in the human body, but only a few that commonly require frenectomy, and they are all inside the mouth. Common frenectomies involve the tongue and upper lip.

In some cases, the frenum is too short, tight or tough, and basically does its job too well. The inhibited movement causes difficulty with regular tasks like eating and talking, or hurts proper development in children, leading to aesthetic problems. The frenectomy is the simple procedure by which the frenulum is severed and typically removed to free up more movement. It’s a low-risk, outpatient procedure that is usually successful the first time in solving the targeted problem.

Types of Frenectomy

There are several frenums in the human body, with a few in the mouth and even in the genitalia. But when most people talk about a frenectomy, they are thinking of two or three different types. Frenectomy in all three involves a similar technique to solve different problems.

Labial Frenectomy (upper lip): A labial frenectomy most often involves the frenum attaching the upper lip to the upper jaw, usually in children as their teeth and gums develop. The problem of the upper labial frenum is primarily one of aesthetics, but not necessarily. If the frenum is too short or tight, there are a few common issues. For one, the ligament tissue can extend toward the two upper front teeth and cause a diastema, or gap in the teeth. It can also create an “open mouth posture,” by limiting the movement of the lip and preventing the mouth from properly sealing. This leads to open mouth breathing, which in children impairs the development of nose breathing and by extension proper airway and jaw development. It can also cause gum recession.

Lingual Frenectomy: The lingual frenum is the tight cord underneath the tongue that tethers the tongue in its resting position. In most people, there’s sufficient flexibility that the tongue can move around and perform its functions for speaking and eating. But again, if it’s too tight or short it restrains the tongue too low. This is commonly referred to as being “tongue-tied.” This has a couple of problems associated with it. For one, if the tongue is held too low, in young children it will hinder correct growth of the jaw and cause long-term orthodontic problems and sometimes sleep apnea. Second, it can keep the tongue from pressing properly against the upper palate during swallowing, pressing it instead between the teeth and preventing the bite from closing all the way over time. Finally, being tongue-tied is a common culprit for lisping.

Labial Frenectomy (lower lip): The lower lip frenectomy is done for similar reasons as the upper lip, generally to stop periodontal problems and gum recession. But it is also performed in older adults who are being fitted for dentures. When the lips move, the frenum can pull the dentures loose, leading to improper fit.

The Frenectomy Procedure

There are a few different ways to perform a frenectomy, but they are all fairly low impact and heal in a relatively short amount of time. The most basic frenectomy procedure is done with a scalpel or scissors. It is quite simply when a doctor uses an incision to release the frenum and excise it. The immediate area will be numbed usually with a topical anesthetic, and sometimes in young children laughing gas will be used to relax the patient. Depending on how much of frenum is severed or removed, there may be sutures to reposition the tissue. Usually dissolvable sutures will be sufficient.

A true frenectomy describes the removal the frenum, but in the case of a very young infant, it may be possible to just clip it.

There is another newer, more frequently used technique involving laser surgery. The procedure performs basically the same tactic, but uses a small laser to zap the frenum with pulses, gently severing the tissue. Doctors like this version of the frenectomy, since it tends to reduce bleeding, cause less tissue damage, and improve healing and post-procedure pain.

Reward and Risk

The benefits of a frenectomy are usually fairly immediate and positive. The procedure itself takes only a few minutes usually, and will cause discomfort for just a couple of days. The site will usually heal in a couple of weeks. Aside from the long-term periodontal improvements to remedy the problems described above, in babies it can solve problems with nursing. When done early on in the case of a lingual frenectomy, it can be a much simpler procedure than waiting until later in childhood or adolescence.

As with any surgery, there are some risks. For one, there is the possibility of the surgery not being sufficient and needing to be redone. Or the frenulum may reattach, but this is pretty rare. There’s the aforementioned discomfort in the days following the procedure. There’s also the possibility of excessive bleeding, hematoma and post-surgical infection. In addition, following a lingual frenectomy, there may be a need for speech therapy exercises to train the patient to properly use the tongue, once it’s been freed and has newfound mobility.

Post-Procedure Care

After the procedure, the area will look like a large sore, and there may be slight bleeding. But this is generally not cause for concern. If there is bleeding, simply fold a piece of gauze and place it on the wound to soak up any blood. It’s important to keep the area clean, by gently swabbing with a piece of gauze and peroxide. A doctor may advise topical use of vitamin E oil. Patients will need to monitor the area for about a week, and if there are any complications, return to the doctor.

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