In a newborn, this is a fairly common problem that parents are increasingly faced with today. If it is detected in a timely manner, there is no reason to worry. In this article we will tell you why such a defect appears, how you can identify it yourself, and in what cases surgery is required.
Anatomical features of the frenulum under the tongue
The frenulum is a thin bridge that is located under the tongue and connects it to the lower part oral cavity. It is completely covered with mucous membrane. Thanks to the membrane in the sublingual region, this organ is constantly held in a certain position.
There are also two more bridges in the oral cavity: the upper frenulum and the membrane between the lower lip and gums. Together, they provide lip motility, articulation, and the process of chewing food.
The length of the hyoid frenulum in an adult is no more than 3 cm, in a newborn it is only 8 mm. Normally, it does not interfere with tongue movement, conversation, or eating.
A short frenulum in a newborn is considered a pathology. The severity of this defect depends on the length and location of the organ. The most difficult case is when the front end is attached directly to the tip of the tongue, tightening it. In this case, the tongue practically does not rise. Even when silent, it remains between the teeth.
Main causes of the defect
In approximately 50% of cases, the pathology is inherited from one of the child’s parents. The formation of the frenulum is directly influenced by the behavior and well-being of the mother in the first trimester of pregnancy. Taking hormonal medications and antibiotics can negatively affect the development of the baby's oral apparatus.
A certain role in the development of this anatomical defect belongs to the age of the woman in labor, unfavorable environmental conditions, bad habits. All these factors together can affect the child’s health. As medical practice shows, a short frenulum occurs in one newborn out of a thousand babies, and the pathology is more often diagnosed in boys.
Signs of a defect
A short frenulum in a newborn has a number of characteristic signs, so it is very easy to determine the presence of a defect. Usually it is eliminated in the hospital.
The very first sign of pathology is a heart-shaped tongue with the tip slightly pulled back. Doctors also call other symptoms:
- The feeding process takes a long time, the baby cannot hold the breast in his mouth for a long time.
- A newborn does not gain weight well due to not getting enough to eat.
- When feeding, the baby chews and bites the nipple, smacking.
- At the end of feeding, he is always accompanied by painful colic.
- A woman's appearance changes, characteristic cracks appear.
Sometimes the amount of milk produced by a mother decreases, since this process requires a certain stimulation, and the child cannot provide it in full.
Short frenulum and breastfeeding
This anatomical feature can be easily identified by improper latching, as well as breastfeeding in newborns. If the bridle is not trimmed in a timely manner, the baby will not be able to eat fully and over time will begin to noticeably lag behind in weight. You should also not deny him breastfeeding, because the woman runs the risk of losing milk.
As a rule, babies with this pathology more often ask for the breast, quickly refuse it, or it simply constantly slips out of the mouth. The child cannot “suck” correctly and fix the tongue in the desired position. The latter is directly involved in the process of milk production. When tongue mobility is limited due to anatomical features, the newborn has to use his gums and lips during feeding. As a result, the baby begins to bite and chew the nipple, which is accompanied by unpleasant sensations for the mother. The child himself also gets very tired. Due to severe overstrain of the jaw muscles, tremors are sometimes observed.
Thus, breastfeeding is usually ineffective, uncomfortable, and requires a lot of effort for a newborn diagnosed with a lingual frenulum.
How to determine the defect yourself?
The length of the frenulum in a newborn should be at least 8 mm. To identify the defect, it is enough to pull the lower lip so that the child opens his mouth slightly. You can visually determine whether the frenulum is really short. This is evidenced by the fact that the tongue is attached near the very tip, that is, it barely touches the lips.
The easiest way to identify pathology is in children 2-3 years old, when they are already starting to speak. If diction or pronunciation of certain sounds is incorrect, parents usually take the child to a speech therapist. It is the specialist who identifies the birth defect. If parents discover it early, treatment of the frenulum can be done with massage or
How to eliminate pathology?
If an anatomical defect is found in a newborn baby who cannot breastfeed, the problem is corrected immediately in the hospital. This operation does not require anesthesia, since the frenulum is devoid of nerve endings and therefore insensitive to pain. The procedure itself is very easy and absolutely safe. After this, the baby is immediately put to the breast. Milk helps stop bleeding and promote rapid healing of the injured area.
The frenulum can also be trimmed in children a few months old. In this case, the operation is performed under local anesthesia. Classic method using surgical scissors is also applicable, but today doctors increasingly prefer to resort to electrocoagulation. Modern laser surgery has the necessary techniques to eliminate this defect.
At what age is it better to have surgery?
To ensure that the surgery is as painless as possible, it is recommended that it be performed in the first weeks of the baby’s life. Over time, the membrane thickens. For example, a nine-month-old child already requires anesthesia and suturing during surgery.
If this time is missed, the next appropriate moment is considered to be the period when the baby is already 2.5 years old. At this stage, pronunciation is consolidated, but pronunciation is not yet fully formed.
The next favorable period is five years. At this age, baby teeth are replaced with permanent teeth and a bite is formed.
Modern laser surgery allows this type of surgery to be performed at any age. The intervention is not particularly difficult for a qualified doctor. The operation lasts a few minutes and is not accompanied by future complications. However, after surgical treatment of older children, additional speech therapy is required.
Possible complications
Difficulties with feeding are not the only problem that a short frenulum entails in a newborn. Incorrect functioning of the tongue affects the formation of the jaws and bite. Sometimes this pathology serves as a predisposing factor to the occurrence of gingivitis, periodontitis and other dental problems.
If the anatomical defect is not corrected in a timely manner, in the future the child may have difficulties with diction and sound pronunciation. In such cases, additional help from a speech therapist is required. Other unpleasant consequences include the formation of interdental gaps, excessive saliva production, and night snoring.
Conclusion
Unfortunately, today doctors are increasingly diagnosing a pathology such as short frenulum in newborn children. What to do with such an anatomical defect, how to identify it yourself, you can learn from the materials in this article.
With timely detection of pathology and surgical intervention, the prognosis for most children is favorable. Thanks to cutting the frenulum, breathing improves and the child gains weight. Unpleasant symptoms, by which the presence of such an anatomical defect can be determined, gradually disappear. The sooner a specialist performs this procedure, the higher the likelihood of preventing malocclusion and problems with diction. Remember: the health and well-being of the baby is in the hands of the parents.
Today, a third of newborns have a short frenulum of the tongue. In medical practice, the disease is known as ankyloglossia. Signs of the disease can be first detected by doctors in the maternity hospital during the first examination. Additionally, it should be noted that the pathology is much more often diagnosed in boys than in girls. However, it is not always possible to detect an anomaly immediately after birth.
The frenulum is a small film that connects the root of the tongue with its bottom. In its normal state it is very thin and does not interfere with movement. A short frenulum in a newborn can be one of the following types:
- A detailed examination may reveal incorrect attachment. In this case, the combination can start directly from the root itself and end at the middle. In normal condition, its length should be 8 millimeters. However, in a baby with abnormal anatomy, the length of the tongue frenulum can reach 17 millimeters. Violations are also observed in the nature of attachment. In this case, the mobility of the tongue is noticeably limited. The baby cannot pull it forward to the required level. In some cases, movement is completely limited.
- The interaction area is too small. When measured in detail, the frenulum is less than eight millimeters long.
If an infant is diagnosed with this pathology, then in the future this threatens with improper speech development. It is necessary to direct all efforts to eliminate the disease. In this case, serious consequences will be avoided in the future.
Characteristics of normal and short frenulum
Parents should know what to do if they suspect this pathology in their child. At the first stage, it is necessary to carefully examine the oral cavity.
Variants of manifestation of pathology
To determine the short frenulum in infants, there are three methods that are actively used in medical practice:
- If the newborn has the correct frenulum position, he will be able to easily stick out his tongue and move it from side to side. It is easy to check the reflex: for this, the parent just needs to touch his lower lip with one finger. In this case, the baby is obliged to stick out his tongue and move it in search of the necessary object. Otherwise, the baby will not be able to perform such manipulations. You can also try to move your tongue from side to side on your own. With such manipulations, the baby should not experience any discomfort.
- Parents should be aware that in the case of a short frenulum, the newborn will not be able to touch the roof of his mouth with his tongue. At normal length, this action should not cause difficulties. Additionally, it should be noted that in infancy, all children tend to actively move their mouth. Thanks to this, they gain the necessary experience and develop their speech complex. Mommy knows that if the baby wants to eat, he begins to regularly open his mouth in anticipation of the nipple. That is why good parents will not take much time to analyze the position of the frenulum.
- It is imperative to pay attention to the position of the tongue at the moment when the child begins to act up and cry. However, newborns can express dissatisfaction in other ways. If the frenulum is in normal condition, then the tongue should always be raised up. Its edges can also be raised, but the middle should always remain in a static position. It is regulated by a ligament.
The diagnosis of a newborn can only be made by a specialist in this field. To do this, you will need to visit the office of a neonatologist, pediatrician, dentist or orthodontist.
Causes of short frenulum
Most often, changes in the development of this organ are observed against the background of a hereditary predisposition. That is why it is advisable to ask your closest relatives about the presence of such an anomaly in childhood. If it has been recorded, it will most likely appear in some children of this couple.
If a child has a small frenulum, this indicates that it developed under the influence of the following negative factors:
- In the first trimester of pregnancy, a woman was exposed to the influence of several negative factors on her body. Among them, stress, toxicosis, the spread of viruses and the influence of harmful chemicals are of particular importance. During this period, it is also not allowed to undergo treatment using antibiotics. They can negatively affect the growth and development of all internal organs baby.
- A woman's pregnancy began to develop after age 35.
- To date, it has not been possible to establish the exact cause of the development of short frenulum in infants.
Why is it necessary to eliminate a short frenulum in a child?
Additionally, it is necessary to determine what kind of inconvenience this pathology presents for the child. First of all, it should be noted that the baby cannot breastfeed normally. He experiences discomfort during swallowing and sucking.
With a detailed examination of the child, you can visually determine the cause of the malaise. The baby becomes capricious and begins to lightly bite the nipple while sucking the breast. From time to time, mommy may also hear clicking sounds. The situation develops against the background of the fact that the child’s tongue prevents him from properly absorbing food. Posture plays an important role in this matter.
A normal diet should include not only foremilk, but also hindmilk. The baby should empty the mother's breast completely. In this case, he is guaranteed to be healthy, develop well and gain weight quickly. Otherwise, the risk of malnutrition increases, which is dangerous and can lead to the development of serious diseases.
A woman should not place all the blame for what is happening on herself. The situation does not always mean that her milk is low-fat and is not an ideal source of nutrition for the baby. You should not immediately switch to the mixture. Everything must be done to maintain lactation. With mother's milk, the baby will be guaranteed to receive the entire volume of elements necessary for its growth and development.
Experienced mothers know that milk will only remain if the baby sucks it well. Families that have their first child should learn about this in time. If parents notice that their baby is very capricious, cries and refuses to suckle, then it is necessary to independently check the position of the frenulum.
If a child has a short bridge, then in the first two months he will gain very little weight. This can also be explained by the content large quantity hormones in milk that remain in a woman’s body after pregnancy. In some cases, breast stimulation can help solve the problem. Within three months, the process, as a rule, normalizes, and the baby begins to receive sufficient nutrition. The situation with weight gain should also improve.
A short frenulum can cause a number of problems in the development of a child:
- There is no way to chew food well on your own.
- The situation negatively affects the position of the teeth and bite. Against this background, the incisors on the lower jaw will be turned inward.
- Serious speech impediments.
- Incorrect breathing.
Trimming
By far the most effective way To eliminate the defect, surgical intervention is considered - frenulotomy.
Trimming the frenulum in this way has several advantages:
- The operation is simple and does not require special preparation. The surgeon makes a small incision in the area from one third of the tongue to the tip.
- If necessary, the mucous membrane is sutured on both sides.
- The operation is simple, so it can be performed in the maternity hospital. Age does not affect the effectiveness of the operation in any way. However, what smaller child the better. In this case, only a small number of blood vessels and nerve endings will be affected.
Surgery in the upper part takes place without anesthesia. It has been scientifically proven that the baby will not feel pain. The frenulum consists entirely of mucous tissue. The only problem is that the child will need to spend a certain period with his mouth open. Additionally, you need to pull back your lips, which block the doctor’s view. It is recommended to carry out the procedure for up to nine months.
It will take several hours for the baby to return to normal. It is best to apply it to your chest during this period. In this case, the baby will feel safe and will be able to eat well. He may even lightly suck on the breast. Thanks to this manipulation, feeding will now become as comfortable as possible for him.
Glickman's method involves using a similar procedure. The difference lies in the need to fix the frenulum using a special clamp. Only after this should the tissue be dissected.
A neonatologist can detect a short tongue tie even in the maternity hospital
Vinogradova’s method involves the following manipulations:
- The bridle is trimmed in the shape of a triangle. After this, it is sewn back to the wound. It is important to properly treat wounds.
- The operation can only be performed if the child has passed all the tests. Anesthesia is expected.
- The duration of the operation is no more than ten minutes.
- During the rehabilitation period you should not drink hot water and eating food that can scratch.
- It will take no more than a day for the wound to heal. However, for several weeks it is imperative to adhere to all the rules of personal hygiene.
Experts' opinion
Ankyloglossia still causes a lot of controversy today. The decision to trim the frenulum should be made by the parents. This bridge can cause many problems and interfere with breastfeeding. Surgical intervention should be performed in the following cases:
- The dentition begins to shift.
- Bite distortion.
- The child has pronunciation defects.
The feasibility of the operation is assessed by the doctor. Thanks to its implementation, infants' appetite increases. Trimming can prevent the development of speech defects that become a habit for the child.
If a deformation of the frenulum is detected, parents should not panic. It is necessary to closely monitor the child's appetite, well-being and weight gain. If the deformation is minor, it may go away on its own with age.
The operation must be performed if the baby has problems sucking the breast. The situation can be corrected within ten minutes. Otherwise, the baby may simply refuse to breastfeed. A shortened frenulum may also lead to incorrect pronunciation and the development of serious speech defects in the future.
Tongue frenulum- hypoglossal ligament that attaches the tongue to the floor of the mouth. Ankyloglossia, that is, a short frenulum, is considered a small congenital developmental anomaly. In this case, the ligament begins too close to the tip of the tongue, sharply fixing it in front.Ankyloglossia can be accompanied by problems during breastfeeding, speech development and breathing.
Symptoms of a short frenulum of the tongue in newborns and older children
The diagnosis of ankyloglossia can be made at any age.
For the first time, the length of the tongue frenulum is checked by a doctor in the maternity hospital. If this pathology is diagnosed, in most cases the frenulum is immediately dissected.
Sometimes ankyloglossia is detected in children at an older age, or in adults when symptoms of this developmental anomaly appear.
Symptoms of a short frenulum of the tongue in infants:
- “Smacking” sounds when feeding;
- Breast biting;
- Large number of feedings on demand;
- The child often abandons the breast and rests, spends a lot of time at the breast;
- Insufficient weight gain;
- Whims at the chest;
- Refusal of breastfeeding.
Symptoms of a short frenulum of the tongue in children after one year and adults:
- Organic type of dyslalia (pronunciation of palatal, hissing and whistling sounds is difficult due to limited mobility of the tongue);
- The inclination of the lower jaw incisors is inward;
- Malocclusion;
- Poor fixation of removable dentures and implants;
- Periodontitis and gum recession.
Ankyloglossia can be diagnosed by a pediatrician 
neonatologist, general pediatrician, dentist, surgeon, otolaryngologist.
Parents may suspect that their child has a tongue tie and consult a specialist.
At home, you can ask a child over 2-3 years old to perform small tasks to determine the length of the frenulum.
- Ask your child to stick his tongue out of his mouth. A child with a short frenulum cannot stick out his tongue or the tip of his tongue tends downwards.
- Ask your child to raise his tongue to the roof of his mouth. With ankyloglossia, a dimple forms at the tip of the tongue, and the tongue rises more to the sides. Often the baby cannot run his tongue along the gums at all and touches the tip to the roof of his mouth.
By visually examining the oral cavity, you can estimate the length of the frenulum. Even in a newborn child this figure is more than 8 mm. At the age of 5 years, the length of the frenulum should be more than 17 mm.
Signs of a short frenulum of the tongue are divided into absolute and relative:
Depending on the presence of signs of shortening and the length of the frenulum, the degree of limitation of the function of the tongue is determined.
Limitation of tongue mobility:
- Mild degree. The length of the frenulum is more than 15 mm, combined with the presence of relative signs and accompanied by a violation of sound pronunciation.
- Average degree. The length of the frenulum is less than 15 mm, there are absolute signs and/or relative signs.
- Severe degree. The length of the frenulum is 0-10 mm, there are absolute signs of shortening.
Indications for surgery to trim the short frenulum of the tongue
Trimming the short frenulum of the tongue (frenulotomy) is a simple operation. It requires only local treatment 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:
- Severe degree of limitation of tongue mobility;
- Average degree of limitation of tongue mobility with unsuccessful therapeutic treatment;
- Impaired nipple latching during breastfeeding, insufficient weight gain in an infant;
- Forming malocclusion;
- Emerging dentition displacement;
- The need for orthodontic structures (removable dentures);
- The need to install implants (dentures).
If in infancy the child had no problems with
food intake, the dentition is formed correctly, and a speech therapist reports about ankyloglossia for the first time, it is recommended to first undergo a course of speech therapy ( articulatory 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.
Trimming the frenulum of the tongue younger age Usually limited to simple dissection (frenulotomy), in children over 5 years of age and in adults, plastic surgery of the sublingual fold may be required.
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Often parents do not pay attention to the development of the tongue frenulum in their newborn child. In fact, this must be done, because sometimes the jumper is too short. In this case, by the age of 3-5 years, problems with pronunciation and bite formation begin. To avoid this, it is necessary to regularly examine the child's oral cavity.
Causes
Most often, an underdeveloped frenulum under the tongue occurs due to hereditary factor. It is worth noting that such a pathology can be observed as a result of some problems during gestation. This is explained by the fact that the course of pregnancy has a significant impact on the development of the frenulum in children. Towards the formation of pathology may result from the following factors:
- early prolonged toxicosis;
- taking hormonal drugs and antibiotics in the first and third trimester;
- various injuries to the abdomen of a pregnant woman;
- past infections;
- unfavorable environmental conditions;
- stress and depression;
- late age of the woman in labor, that is, over 40 years old.
Main features
First of all, it is worth noting that it is from the language sucking function depends newborn baby. Due to the mobility of this organ and proper development All organs of the oral cavity the baby receives the necessary nutrition. If the tongue frenulum is too short, the baby may experience discomfort when sucking milk. This process causes pain and makes the baby capricious. In addition, the woman herself experiences pain. The reason for this phenomenon is considered to be the fact that the child is not able to grasp the areola. As a result, a significant part of the milk flows out of the newborn's mouth, which leads to reduced weight gain and even refusal to eat.
Symptoms and possible consequences
Any mother, upon careful examination of the oral cavity, can notice a short frenulum of the child’s tongue. In addition, a pediatrician or pediatric dentist can detect the problem.
About the presence of such a pathology Several factors indicate:
- During feeding, the baby constantly smacks his lips;
- the baby may bite the nipple hard, which will cause discomfort to the mother;
- the need for frequent breastfeeding;
- the child does not eat enough and begins to be capricious;
- insufficient weight gain occurs.
If parents did not notice the presence of pathology under the tongue in time, then the likelihood of developing various complications increases significantly. This could be periodontitis, abnormal tooth formation, or gingivitis. In any case, due to a short frenulum, the entire articulatory apparatus of the child suffers. So, the baby cannot pronounce certain sounds. His speech is significantly distorted due to the fact that his lower jaw does not move well. After 5 years, there is no point in performing an operation, because even it will not help restore the pronunciation of some sounds.
Diagnostics
Frenum length in newborns must be at least 8 mm, and in an adult the jumper reaches 2-3 cm in length.
To determine the presence or absence of pathology in a newborn, it is enough to gently pull the lower lip so that the child opens his mouth. Visually you can see whether the frenulum is really short. This is evidenced by the fact that the tongue is attached near the tip. Accordingly, he barely touches his lips.
The easiest way to notice is a short jumper in children 2-3 years old. So, the child is already starting to speak. If some sounds are pronounced incorrectly, parents take the child to a speech therapist. It is the specialist who determines whether the child has a congenital pathology. If you notice it as early as possible, then it is enough to perform special massage and articulation exercises.
Treatment
To eliminate a congenital anomaly, 2 methods are suitable: stretching the short frenulum in newborns using special exercises or surgery. The second option is considered preferable for infants. For this purpose, a laser or scissors is used. In the case where the bridge is under the tongue a little short of normal, and during breastfeeding there are no problems, surgical intervention is not necessary.
In most cases, the frenulum of the tongue is cut at 1 month of the baby’s life, because subsequently this organ becomes too susceptible to various surgical interventions. The reason for this fact is the deep placement of blood vessels. Calming your baby after surgery is very easy. For this purpose, you need to drop a few drops of mother's milk onto the wound.
There are no complications with this operation. Moreover, thanks to it, the baby’s articulatory apparatus develops correctly. The procedure itself takes no more than 5 minutes, and the child does not require anesthesia. There is no blood or pain during cutting, because the nerve endings have not yet formed in these tissues. The incision heals within 1-2 days, and the threads dissolve on their own.
A similar operation usually carried out up to 1 year Therefore, during the next examination, the pediatrician should carefully monitor the condition of the child’s mouth and tongue. If the defect was noticed after 3-4 years, you must contact a pediatric surgeon to trim the frenulum. Over 5 years of age the operation is no longer carried out.
The prognosis for trimming the lingual frenulum is good. Thanks to the dissection, breathing and sucking are significantly improved, and the necessary weight gain occurs. The sooner the procedure is performed, the higher the likelihood of avoiding problems with the formation of speech and bite. For older children, cutting the frenulum under the tongue will not help normalize speech, so you will have to visit a speech therapist. In some cases, conservative treatment is prescribed, that is, children aged 2-4 years must perform special exercises that will help stretch the frenulum.
A short frenulum under the tongue is a common pathology in newborns. With a strong degree of development of the defect, it has an extremely negative effect on the development of the child: it complicates breastfeeding, disrupts the structure of the dentition, and leads to problems with the speech apparatus.
In this text you can learn about the signs by which pathology can be identified and cured in the most painless way possible.
Signs of pathology
A congenital defect of the frenulum is detected by a number of signs. They are visible to the naked eye and are diagnosed by a doctor during the initial examination of the newborn.
The main one is the unusual shape of the tongue with the tip slightly pulled down. It looks a bit like a small heart.
There are secondary factors that manifest themselves during feeding in the baby and the mother:
- The baby smacks his lips and releases the nipple, which increases the duration of the feeding session and, in general, it becomes quite difficult to feed the baby.
- Without eating, the baby gains weight worse.
- Due to poor nutrition, colic occurs more often in a child. He regurgitates food.
- The pathology does not allow the newborn to hold the mother's breast correctly, which is why cracks and bite marks remain on the nipple, and less milk is produced.
If these symptoms appear, you should take a close look at the child.
What does a shortened frenulum look like?
Violation of the frenulum length can be understood in three ways:
- Firstly, the baby cannot stick his tongue out of his mouth, only slightly raising and lowering its edge. To test this reflex, you can run your finger over your baby's lips. At normal reaction The baby sticks his tongue out quite far, moving it around his lips in search of mother's milk.
- Secondly, the surest way to identify a small frenulum is to watch your child cry. When screaming, the tongue should rise strongly, and if there is a disease, only the very tip will lift up.
- Third, a child with a frenulum defect cannot reach the palate with his tongue.
If these signs are not enough for parents to be convinced of the need for treatment, they can contact any pediatrician for a diagnosis.
The photo shows a short frenulum of the tongue
Causes of the defect
The most common cause of the defect, provoking half of the cases, is a genetic predisposition and hereditary factor.
Another reason is the use of hormonal medications and antibiotics by a pregnant woman. Moreover, the most dangerous period is the first trimester of gestation. This factor also influences the formation of other oral pathologies.
A certain motivating factor in the formation of pathology can be late pregnancy - after 35 years, but this is not at all necessary and has a negligible effect.
The exact causes of this problem have not been studied, so sometimes it appears even without obvious reasons.
What can pathology threaten and interfere with?
The anomaly harms not only the baby, but also the grown child.
Among negative consequences professionals highlight the most dangerous:
In general, despite the painlessness and absence of a threat to life, a short frenulum greatly affects the development of the baby and causes a lot of problems for an older child, so it needs to be eliminated as soon as possible.
Problems with breastfeeding
This consequence of the anomaly concerns not only the health of the baby, but also his mother. Therefore, we should talk about this in more detail.
The baby's anatomy is designed in such a way that he actively uses his tongue when latching on to the nipple. However, the short frenulum does not allow him to use this organ, so the gums and lips come into play.
Note! This causes a lot of stress on the chewing apparatus, which makes the baby tired. His jaw may tighten, and while feeding he will cling and bite the breast strongly, causing discomfort to the mother.
After such feeding, the nipple becomes as if pinched or beveled, like the edge of a purchased lipstick. Due to increased friction, a watery bubble forms on its front part, and sometimes the skin cracks, which is accompanied by severe pain.
Due to the weakened retention of the nipple in the mouth, the baby begins to grab onto it with all his might. Increased squeezing to express milk leads to pain, which is dampened by the nourishing fluid that moisturizes the breasts. Therefore, pain may not occur immediately, but some time after eating.
On the left is the correct position of the tongue. On the right - short frenulum of the tongue
Degrees of anomaly
In pediatrics, there are several degrees of pathology of the frenulum under the baby’s tongue:
| Degree | Symptoms |
| I | Thinning of the frenulum up to a translucent state and its shortening, which prevents the normal mobility of the tongue. |
| II | A frenulum with a defect is attached close to the end of the tongue, causing it to resemble a heart when raised. |
| III | The short, thickened section of the frenulum is also located close to the edge, which is why the tongue bends in a slide when lifted. |
| IV | A massive cord penetrates the muscular structure of the tongue, which usually occurs in parallel with a cleft lip or palate. |
| V | The dense area of the frenulum almost does not appear against the background of the tongue and fuses with the muscles, severely limiting the latter’s ability to move (the so-called ingrained tongue) |
Thus, the danger of pathology increases depending on the degree of limitation of tongue mobility.
Diagnostics
How to identify the problem yourself
The correct length of a baby's frenulum is considered to be 8 mm and above. To take the measurement, you should pull back the lower lip so that the baby opens his mouth. If the tongue is attached at the very edge and does not reach the lip, then most likely there is a shortening of the frenulum under the tongue.
For older people, a characteristic syndrome is identified when problems are detected with pronouncing individual letters (usually a lisp) and seeking help from a speech therapist.
How does a doctor diagnose?
Diagnosis of pathology is carried out by collecting anamnesis and visual examination of the patient
There are many child health specialists who can diagnose frenulum shortening:
- pediatrician;
- surgeon;
- neonatologist;
- dentist;
- orthodontist;
- speech therapist.
Diagnosis of pathology is carried out by collecting anamnesis and visual examination of the patient. The Haselbaker test, which takes into account the size of the frenulum and the mobility of the tongue, can help determine the disease.
In particular, according to the doctor’s method, it is considered normal if the bridge is longer than 0.8 cm, and the baby can easily reach his lips with his tongue and can lift it to the sky.
Operation
Often the best way To eliminate the frenulum anomaly is to perform an operation.
In what cases is this necessary?
Typically, surgery is prescribed for severe defects that make feeding difficult.
Surgical correction begins in the first days of the baby’s life. Typically, surgery is prescribed for severe defects that make feeding difficult.
An alternative method is non-interventional therapy. It involves classes with a speech therapist using a special technique, as a result of which the frenulum stretches and the mobility of the tongue improves.
Conservative treatment is prescribed to an older child when the first speech defects appear.
At what age is it better to have surgery?
The best time to trim the frenulum under the tongue is during the first few weeks of life.
The next period is 9 months after birth. In this case, the skin growth grows a little, so its dissection will require anesthesia.
Important! At the age of 5, the child begins to grow permanent chewing organs. Plastic surgery of the frenulum during this period will be productive, as it will allow you to avoid wearing braces.
After 5 years of age, surgical removal of the defect no longer makes sense, since the child develops stable pronunciation skills and chewing organs, taking into account the pathology. In such cases, an orthodontist or speech therapist provides conservative therapy.
When treatment is carried out without anesthesia
Surgery on newborns does not require anesthesia, since their blood vessels and nerve endings in the frenulum have not yet formed. In addition, the drugs included in painkillers can harm the baby’s body. In subsequent years, the procedure becomes painful and requires preliminary local anesthesia.
In general, the older the patient, the more painful and serious the surgery to cut the hyoid frenulum will be.
How to do it
Frenuloplasty is performed using several methods: using a scalpel, laser or scissors. Depending on the age of the patient, local topical anesthesia is used or not, or painkillers are administered.
How is rehabilitation going?
In newborns, regenerative processes in tissues occur much faster. A small incision heals literally 2-3 hours after the surgeon’s intervention. The procedure does not leave scars or other consequences, since the wound heals within the fourth hour of rehabilitation. To check the results, the baby is immediately given breastfeeding so that the mother can evaluate the changes.
After cutting the frenulum at an older age, rehabilitation takes a little longer:
- First, the doctor will apply stitches, so the patient will need a follow-up appointment.
- For 4-5 hours after surgery, the child should not eat or drink any drinks other than water.
- To prevent infection, it is recommended to treat the oral cavity with antiseptics, which are recommended by the doctor.
Intervention after the age of 3 years may leave a small scar.
Operation options
There are only 3 options for surgery to correct the length of the frenulum:
| Name | Description |
| Frenulotomy | This type of intervention is considered the simplest. The patient's frenulum is cut in the area of the first third of its length, counting from the gums. The doctor then tightens and sutures the edges of the tissue or does without it when the operation is performed on a newborn. |
| Frenulectomy | This method is also called the Glickman method. The difference from the first option is that before cutting the frenulum, the desired area is fixed with a clamp. This is done to accurately localize the point of penetration of the tool. |
| Frenuloplasty | This operation is a little more complicated, since the doctor not only makes an incision, but also cuts out a small triangular flap from the frenulum, which is then sewn back on. This method not only lengthens the frenulum, but also, after removing excess mucous membrane, makes it thinner and more elastic. The total duration of the operation does not exceed 15 minutes, and the patient feels the changes the very next day. To prevent complications, doctors prohibit eating hot and solid foods during the next week. |
After treating a baby, positive changes from the procedure appear almost immediately. The baby's appetite awakens and he no longer bites his breast.
Important! If the anomaly is corrected in a timely manner, it does not cause complications in speech and the chewing system.
However, if the frenulum is cut for children of kindergarten age, after plastic surgery it is necessary to undergo a course of treatment from a speech therapist and an orthodontist, since the intervention only eliminates the mechanical cause of problems with speech and chewing food.
If the patient has formed stable reflexes and a permanent dentition has been established, further correction will require appropriate therapy.
Is treatment for a defect always necessary?
In most infants, this pathology has only a minor effect on health, and sometimes is not diagnosed at all.
Typically, indications for surgery include serious developmental problems in the infant.
In most infants, this pathology has only a minor effect on health, and sometimes is not diagnosed at all.
If a defect is detected in a 5-year-old child, treatment is not prescribed. It will no longer be advisable, since it will not correct the bite and speech.
It is much more effective to correct the position of the teeth and develop the speech apparatus from the appropriate specialists.
Possible complications after the defect
Modern treatment does not cause complications.
However, if the situation remains unchanged, the risks of diseases of the oral cavity and respiratory system may increase:
- gingivitis;
- periodontitis;
- increased salivation;
- snore.
Probability of occurrence side effects from therapy today is considered negligible.
Short frenulum of the lip in a newborn
Sometimes shortening of the frenulum can also occur in the area of the upper lip. This anomaly is not considered dangerous as it does not affect nutrition or pronunciation. However, in some children, due to the defect, a diastema develops - an abnormally wide gap between the two front teeth of the upper row.
Surgical treatment of this deviation is not required, since it is eliminated with braces or independently when the upper canines erupt.
