Short frenulum of the tongue - parents encounter this problem around the time their baby turns 3-4 years old. He has been trying to speak for a long time, knows a lot of words, knows how to construct complex phrases, but does not pronounce some words accurately.
Grandmothers assure that in another year the child will “speak out”; mothers work with their children using special methods for early development, but the problem is not solved. If your child is still babbling at 4 years old, it is time to visit the pediatric dentist.
The frenulum of the tongue externally resembles a thin membrane, consisting mainly of connective tissue, the function of which is to attach the tongue to the bottom of the oral cavity.
In other words, a short frenulum of the tongue in a child is some kind of defect in the oral cavity that interferes with the joint movement of the tongue.
In some cases, the frenulum does not look thin at all, which significantly aggravates the situation. Almost half of all parents face this problem. And although a short frenulum can be noticed by a specialist even in newborns, parents learn about it when the baby begins to talk.
Pathology of the frenulum of the tongue can be congenital and hereditary. It should be understood that these concepts are completely different. If a congenital pathology is already present at birth, then a hereditary pathology is most often already present in one of the family members.
The concepts of complete and partial short frenulum of the tongue in a child are also distinguished. The level of discomfort of the child and the type of treatment chosen (surgical intervention or corrective exercises) depend on the type of pathology.
With a full frenulum, the child's tongue is practically immobilized, which makes it much more difficult to pronounce most speech sounds. With this type of pathology, muscle cords form. In the case of partial pathology of the frenulum of the tongue, the role of muscle cords is performed by connective tissue.
Why is a short frenulum dangerous?
A short frenulum is a congenital pathology in which the development and functionality of the ligamentous connection between the tongue and the lower jaw is disrupted. At the same time, the mobility of the tongue in the oral cavity is limited so much that it causes speech problems in the child.
Problems with the frenulum of the tongue in a child can occur in two ways. Young children who are breastfed or bottle-fed and have this pathology may have problems with sucking. This occurs due to the fact that the frenulum of the tongue is so short that it simply does not allow the tongue to function adequately.
With a short frenulum of the tongue, the baby cannot be fully breastfed, due to the fact that it is difficult for him to suck out a sufficient amount of breast milk. Therefore, in this case, immediately after the birth of the baby, he has real difficulties with feeding.
The second option for realizing the problem associated with a pathological frenulum of the tongue is speech defects and they arise much later. Partial immobility of the tongue leads to the fact that the child is not able to pronounce certain sounds correctly; his speech remains similar to babbling, “lisping.”
results
The main goal of tongue frenuloplasty is to prevent tongue dysfunction that occurs subsequently. If you do not trim the folds of mucous membrane, then in the future the child may have difficulties with eating, diction and lip movements.
Don't be afraid of surgery. This is a simple procedure that takes a few minutes, and the cutting of the short frenulum itself takes place in a few seconds. Since the mucous membrane in children is still too thin, the child does not feel pain. Minor bleeding goes away quickly and does not pose any danger.
The help of a qualified dentist is an absolute guarantee of high-quality results and the absence of complications.
Reasons for the development of tongue frenulum pathology in a child
The formation of an anomaly associated with a short hyoid membrane begins before the birth of the child. This is preceded by negative factors, which include:
- genetic predisposition;
- infection of the fetus during pregnancy;
- viral and infectious diseases suffered by the mother during pregnancy;
- mechanical injuries to the expectant mother’s abdomen;
- the age of the expectant mother is over 35 years;
- unfavorable environmental conditions;
- the influence of other factors of unknown etiology.
How to recognize pathology in a child
A neonatologist, pediatrician, or the mother herself can recognize a pathological frenulum of the tongue in a newborn. If during the first and subsequent breastfeedings the baby experiences difficulties and cannot grasp the nipple correctly, then there is a reason to consult a doctor.
The second common sign of a pathological frenulum of the tongue in children is the occurrence of a speech defect when they begin to speak in phrases, namely at 3-4 years. Most often, with this anomaly, children do not pronounce several letters: “zh”, “sh”, “sch”, “ch”, “z”, “l” and “r”. Moreover, the sound “l” is easily pronounced if it is followed by a soft vowel, for example, “i”, “yu”, “e”, “e”, “ya”, in other cases it is simply “swallowed”. If there is incorrect pronunciation of sounds, then an examination by a speech therapist is necessary.
The most common symptoms of a tongue tie in a child are the following:
- the child is not able to reach the front teeth of the upper jaw or palate with the tip of his tongue;
- the child may have difficulty moving the tip of the tongue from one side to the other;
- the front teeth of the lower jaw may have a gap between each other;
- when the tongue is pulled forward, its tip remains flat, square or heart-shaped (that is, the front edge of the tongue seems to bifurcate);
- feeding problems in newborns.
It is important to understand that if the problem of the tongue frenulum exists, then sooner or later it will have to be solved. The sooner measures are taken, the easier and more painlessly the baby will endure them.
How is a short frenulum of the foreskin diagnosed?
As already mentioned, this defect can only be identified during puberty. That is why adolescents going through this stage need to visit a consultation with a professional urologist.
Diagnosis of the disease involves analyzing the patient’s complaints and conducting an examination of the penis, during which a specialist identifies the existing problem. Timely diagnosis and adequate treatment play a vital role in this case. They eliminate the risk of complications and also prevent psychological trauma to the patient, which can be very difficult to treat.
In what cases is it necessary to trim the bridle?
The operation of cutting the frenulum of the tongue is called frenulotomy . It is classified as simple and requires only local anesthesia.
Heavy bleeding during frenulotomy is very rare; after a couple of hours the child will be able to return to the usual rhythm of life.
If a short frenulum interferes with the newborn baby's ability to receive nutrition, it must be trimmed. The decision about surgery is made by a pediatric neonatologist.
For infants, as a rule, the operation is performed without anesthesia, since only the sublingual film of connective tissue is dissected, which has practically no blood vessels or nerve endings.
For children aged 3-5 years, surgery to cut the frenulum is performed under local anesthesia. The dentist decides whether surgery is necessary, and the speech therapist prescribes the referral.
Before the operation, the child needs to donate blood for a detailed analysis, which will display numerous indicators, including the number of platelets and the rate of blood clotting.
Surgical intervention is performed provided that the pathology is moderate or severe with limited tongue mobility. After surgery, speech therapy sessions are necessary.
There are a number of indications for frenulotomy, and limited tongue mobility is not the only one. The formation of malocclusion in a child, displacement and disturbances in the formation of the dentition, low effectiveness of speech therapy and articulation gymnastics, as well as the need to install dental implants or orthodontic structures for the child.
Pathology of the tongue frenulum does not always require surgical intervention. If the child does not experience any discomfort during breastfeeding, and his pronunciation of sounds is satisfactory, then it is likely that a speech therapist will help solve the problem. In this case, the child attends special classes, performs speech therapy exercises, articulation gymnastics, etc.
Treatment of short frenulum of the penis
The only treatment for short frenulum is surgery. Surgery for a short frenulum (frenuloplasty or frenuloplasty) involves lengthening or excision of this skin fold. There are several options for frenuloplasty.
Classic frenuloplasty
It involves transverse intersection of the frenulum followed by suturing in the longitudinal direction. The advantage of this technique is its simplicity (the operation takes a few minutes).
Among the disadvantages of such plastic surgery, we can note the unevenness along the edges of the incision, formed from the remains of the dissected frenulum. Although the latter can be easily excised and leveled.
Z-plasty
Professor N.D. Akhvlediani proposed Z-shaped plastic surgery with the appropriate incision shape for the correction of premature ejaculation. This method is advantageous in the formation of a more mobile, elastic scar.
Complete excision of the frenulum
In some cases, especially when combined with circumcision, it is better to perform a complete excision of the frenulum, which permanently eliminates this hypersensitive area.
Laser and radio surgery
In recent years, new technologies such as laser or radiosurgery have begun to be used in frenuloplasty. More and more patients are seeking laser frenuloplasty. Indeed, a laser or radiosurgical knife allows frenuloplasty to be performed almost bloodlessly and very aesthetically.
Regardless of the option chosen, frenuloplasty is performed on an outpatient basis under local anesthesia. At the request of the patient, it is possible to perform this operation under anesthesia (during sleep).
For suturing, I use thin self-absorbable threads, which provides excellent cosmetic results and eliminates the need to remove sutures.
After surgery, a circular pressure bandage is usually applied, which protects the wound and reduces the risk of postoperative bleeding.
Wound healing after frenuloplasty takes about 10 days. Dressings are usually performed by the patient independently.
Restrictions after surgery relate only to sexual abstinence during the period of wound healing. There is no need to take sick leave or give up sports.
Treatment methods
Problems associated with a short frenulum of the tongue can be solved with medicinal and non-medicinal methods.
Medicinal methods involve surgical intervention of varying degrees.
If the sublingual membrane requires dissection, but it is quite thin and elastic, then the doctor dissects it right at the appointment. In this case, anesthesia is not provided, since the procedure is classified as mild.
More complex types of dissection of the frenulum of the tongue include frenulotomy, which is indicated for children with thicker frenulums. Frenulotomy is performed under local anesthesia with tissue dissection and subsequent suturing.
Complications of this operation may include stomatitis, prolonged bleeding from the wound, infection in the wound, etc. After frenulotomy, the child should receive pureed food for some time, as chewing may be painful.
Non-drug treatment methods include special types of massage, exercises to correct the frenulum of the tongue, and individual sessions with a speech therapist.
Non-drug methods are recommended when the condition of the child’s tongue frenulum is not critical and allows refusal of surgery. The decision on this is made by a speech therapist, pediatrician and dentist. Classes with a speech therapist include various exercises, articulation gymnastics, tongue twisters and poems.
Since a short frenulum of the tongue causes some speech defects, classes with a speech therapist are necessary both in the postoperative period and as a correction.
A massage aimed at stretching the frenulum of the tongue includes a list of special exercises. It is important that the classes are systematic so that they give a positive result.
Massage instead of cutting the frenulum is recommended for children in two cases: if the condition of the frenulum is not so critical and the problem can be solved with non-drug treatment methods; if the frenulum is cut when the child is older (over 5 years old) and the surgery will not solve problems with speech impediment.
Examinations before surgery and contraindications
Any surgical procedure in the oral cavity is a risk to the body. In order to prevent complications after surgery, it is necessary to undergo preliminary examinations prescribed by the doctor. The most significant tests are blood and urine tests, determination of blood coagulation and fluorography.
Contraindications for frenuloplasty are infections of the throat, oral cavity, inflammatory processes in any part of the body
, since pathogenic microorganisms can enter the incision of the mucous membrane. This is why a mandatory examination is carried out before intervention. You cannot operate on patients with cancer or decreased blood clotting.
Exercises for correcting the frenulum of the tongue and in the postoperative period
Postoperative frenulum stretching and correction exercises are aimed at developing new muscle movements of the tip of the tongue inside and outside the mouth. Regular practice will increase the range of movement of the tongue.
Articulation exercises by themselves will not improve speech and will not be able to correct the defect, so it is very important to carry them out in conjunction with individual speech therapy sessions.
The most common and universal exercises for stretching and correcting the frenulum of the tongue are given here in the article. Following them, you can study at home with your child on your own:
- Stretch your tongue forward, then stretch the tip up to your nose, then down to your chin. Relax, repeat the exercise several times (at first, up to five repetitions are enough, gradually the number of repetitions must be increased, bringing them to twenty).
- The exercise is performed by analogy with the previous one, moving the tongue left and right. The number of repetitions is also gradually increased to twenty.
- Open your mouth wide. Use the tip of your tongue to touch the upper incisors and try to press on the teeth with all your might, not allowing your mouth to close. During each execution, mentally count to ten. The number of repetitions is the same as the previous ones.
- The exercise is performed in front of a mirror. The mouth is wide open. When performing the exercise, it is important to monitor the movements of the tongue. Pronounce the syllables “dar-dar-dar”, “nar-nar-nar”, “tar-tar-tar”, etc.
- Sticking your tongue forward as much as possible, alternately “lick” your upper and lower lips.
- Closing your mouth, move your tongue from right to left and back, forcefully pressing the inside of your cheeks with the tip of your tongue.
To achieve good results, exercises should be performed daily, in several approaches, for 15-20 minutes . The articulation of specific sounds can be gradually corrected.
Important! You can begin to perform exercises for the frenulum of the tongue only after the wound has completely healed.
Speech therapy classes should include exercises to improve the functioning of the speech apparatus and oral kinesthesia, without which it is difficult to claim significant improvements in the development of a child’s speech. Many young patients, after cutting the frenulum, begin to speak more quietly and more quickly, trying to “drown out” speech problems.
Patient reviews
“All my life I suffered from speech disorders, I even went to a speech therapist, but I didn’t achieve much effect. Besides, I have a slightly incorrect bite. I didn’t understand what the problem was, but in the end, at a dentist’s appointment, a shortening of the frenulum was discovered. It was quickly trimmed and after a few days I noticed how much easier it became to talk and even eat. Thank you very much to the doctors of the clinic!” Vladislav, 28 years old
“After the birth of the child, I almost immediately realized that he could not moisten milk normally. I was very scared, you never know what kind of disease could manifest itself. But a small frenulum was quickly discovered and plastic surgery was performed. And now there are no problems. Thank you very much!" Alina, 25 years old
“Thank you to the doctors for the quick and painless operation. I am always afraid of any interventions, but here they did it very carefully, without discomfort. Very pleased with the service and results.” Svetlana, 40 years old
Conclusion: Trimming a shortened frenulum of the tongue is a fairly simple operation that does not take much time. It is necessary at any age to restore normal functionality of the oral cavity. Sign up for a consultation at the Smile clinic in Ivanovo for a comprehensive examination and pain-free manipulation.
