Frenectomy
Lingual or labial frenulum surgery involves cutting the frenulum which, as the name suggests, can restrict the movement of the tongue or lip. The operation is performed by an ENT surgeon under local or general anaesthetic, depending on the case.
Find out more about frenectomy or frenotomy from Dr. Delagranda, ENT surgeon in La Roche sur yon.
Qui est concerné par la frénectomie ?
- A lingual frenulum is considered short when the tongue cannot be raised sufficiently to come into contact with the anterior part of the palate, and barely protrudes beyond the lower teeth during a voluntary movement of the tongue out of the mouth (lingual protraction). The tongue appears large and round because it is held down.
- Infants with breast- or bottle-feeding difficulties and a short frenulum: 30% of short frenemas are symptomatic, more often in boys than girls (1:2). Less than 10% of newborns have a frenulum considered short. The newborn may end up with colic, aerophagia, excessive burping, failure to gain weight, fatigue when eating, and small vesicles at the corner of the lips due to excessive compensatory sucking.
- Children with a short tongue frenulum and a pronunciation defect for S, R and Z
- Children or adults who have difficulty playing a wind instrument.
Labial frenulum concern:
- Children under 11 years of age with a diastema of more than 6 mm and a short labial frenulum
- Children with a troublesome short labial frenulum and inter-incisal diastema (large space between teeth) after the emergence of the permanent canines and after orthodontic treatment.
- Adults with gingival recession due to a short labial frenulum
Lingual and labial brakes
The frenulum is a mucous and conjunctive membrane that connects the lips and tongue to the jawbones. The frenulums ensure the harmonious development of the upper and lower jaw bones and the lips during in utero growth.
There are 3 frenulum in the mouth: the lingual frenulum attaches the tongue to the inside of the mandible, the superior labial frenulum attaches the upper lip to the jawbone, and the inferior labial frenulum attaches the lower lip to the outside of the mandible.
- The lingual frenulum plays an important role in tongue mobility and mouth development. To push food backwards into the oropharynx and swallow normally, the tongue must be raised against the palate. If the frenulum is too short, the tongue cannot rise sufficiently and instead moves forward. Instead of developing a flat, harmonious palate, it becomes ogival and the tongue pushes the front teeth forward, creating an anterior gap (lack of contact between the upper and lower teeth) and a maxillary protrusion (protrusion of the jawbones). Ankyloglossia occurs when the tongue’s movements are limited by a short tongue-frenulum.
- The upper labial frenulum may play a role in the presence of a diastema (too large a space between 2 teeth) between the 2 upper median incisors. However, a gap between the permanent central teeth is normal until the permanent canines have emerged. This space should not be touched until the canines have emerged (11-12 years) and orthodontic treatment has been completed. This is because the scar tissue following upper frenectomy may encourage diastema reopening, or prevent normal diastema closure when the permanent canines erupt. If the upper frenulum has to be cut, the orthodontist should be informed so that the teeth can be held in place with a retainer.
- Only cases of severe diastema (>6-8 mm) during the transition from temporary to permanent teeth may justify frenectomy before age 11, to facilitate orthodontic approximation of the central incisors and minimize the risk of paramedian incisors and/or canines protruding ectopically from the palate. The aim of frenectomy is not to allow spontaneous closure of the space, but to facilitate closure through orthodontic treatment.
- The lower labial frenulum is very rarely a source of problems, except when it attaches close to the gum margin and exerts downward tension on the gum, creating retraction that can lead to tooth loosening.
Indications and objectives of brake surgery
When should I have my frenulum cut and sutured?
- Infant with suckling difficulties and short labial frenulum.
- Child with pronunciation defect and short frenulum.
- Child with orthodontist’s request.
- Child or adult with difficulty playing a wind instrument.
- Adolescent or adult socially embarrassed by a tongue that cannot be pulled or licked.
Frenulum surgery objectives?
- Improve infant feeding (shorter feedings, less fatigue).
- Improve pronunciation of certain consonants.
- Facilitate musical practice on wind instruments.
- Reduce the risk of tooth loosening.
The different stages of the intervention
The surgery
When a frenulum is bothersome and symptomatic, it may be removed (frenectomy)or incised (frenotomy). Under local anaesthetic for adults, adolescents and very young infants, and general anaesthetic for others. It involves cutting the lingual frenulum with a laser or scissors in simple cases (frenectomy), and dissecting a little further to remove muscle tissue in more complex cases, or even suturing at 90° to the incision.
Post-operative recovery period
- For children under 6: rinse mouth with water after feeding, for 5 days.
- For children aged 6 to 15: rinse mouth with PAROEX © after feeding, for 5 days.
- For adults and children over 15: rinse mouth with usual mouthwash after feeding, for 5 days.
- Soft diet for 5 days
- Class I analgesics (paracetamol)
- No cessation of sport
- No smoking during the healing period
Complications related to frenulum surgery
In addition to the risks inherent in any surgery involving general anaesthesia, frenulum surgery presents exceptional risks of complications:
- Moderate oral hemorrhage lasting a few seconds.
- Thick scarring, especially on the upper labial frenulum, is not a complication but rather a failure. It is very rare. A new attempt may be necessary.
Frequently asked questions about frenectomy
Here is a selection of questions frequently asked by Dr Delagranda’s patients during consultations for lip and tongue surgery in La Roche-sur-Yon.
Can we cut the frenulum at the maternity?
Yes, if the newborn is not regaining weight and feeding is obviously difficult.
Does my newborn suffer when the frenulum is cut?
No, it may not even bleed. It takes less than 5 seconds.
Fees and payment for the procedure
Frenulum surgery is covered by health insurance. Contact your mutual insurance company to find out whether any extra fees will be covered.
Do you have a question? Need more information?
Dr Antoine Delagranda will be happy to answer any questions you may have about frenectomy. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon in the Vendée.
ENT consultation for a frenectomy in Vendée
Dr Antoine Delagranda will be happy to answer any questions you may have about frenectomy. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon in the Vendée.