Upper Lip Frenectomy: Key Steps, Recovery, and Benefits

A tight or restrictive upper lip frenulum can cause difficulties with speech, oral hygiene, and breastfeeding in infants. In some cases, a minor surgical procedure called an upper lip frenectomy is recommended to improve mobility and function.

This article explores the purpose, surgical techniques, recovery, and considerations related to this procedure.

Lip Frenum Anatomy

The upper lip frenum is a thin band of connective tissue extending from the inner surface of the upper lip to the midline of the maxillary gingiva, just above the central incisors. Made primarily of collagen fibers with some elastic components, it influences lip movement and oral function. While a normal anatomical feature, variations in size, thickness, and attachment point can sometimes lead to functional limitations.

Embryologically, the lip frenum forms during fetal development from the fusion of the medial nasal and maxillary processes. Its morphology varies, with classifications based on insertion—ranging from mucosal (low attachment) to papillary or even penetrating deep into the palatal tissue. High or thick frenal attachments can create tension on the gingiva, contributing to diastema formation or restricting upper lip mobility.

Histologically, the frenum consists of dense fibrous connective tissue with minimal vascularization, influencing healing dynamics following surgical modification. Some cases involve aberrant muscle fibers from the orbicularis oris, exacerbating restriction. Studies indicate a tight frenum may interfere with speech articulation, lip closure, and feeding in infants by limiting upper lip movement.

Purpose Of Procedural Intervention

An upper lip frenectomy addresses functional limitations caused by a restrictive frenum, which can impact speech, oral hygiene, and feeding. In infants, a tight frenum may hinder breastfeeding by preventing proper latch and suction, leading to inefficient milk transfer and maternal discomfort. Research in the Journal of Human Lactation shows frenectomy can improve breastfeeding outcomes when latch difficulties are linked to a restrictive frenum.

Beyond infancy, a restrictive frenum can contribute to dental concerns. A high or thick attachment may create tension on the gingival margin, increasing the risk of gum recession. Additionally, a prominent frenum can prevent midline diastema closure by exerting mechanical resistance. A review in the European Journal of Orthodontics found frenectomy, combined with orthodontic treatment, helps ensure stable diastema closure by removing tensile forces that contribute to its recurrence.

Speech disturbances linked to restrictive frenula vary in severity. While not all cases cause articulation issues, significant restrictions can hinder bilabial sounds like /p/, /b/, and /m/. Clinical observations suggest frenectomy can improve lip mobility, aiding speech clarity, particularly in children developing early speech patterns.

Surgical Approaches

Upper lip frenectomy can be performed using different techniques based on anatomical presentation and functional concerns. Traditional scalpel excision remains widely used, employing an elliptical incision to release fibrous tissue. This method allows precise tissue removal and is often performed under local anesthesia in older children and adults. Sutures may be placed to approximate wound margins, especially for thick or deeply inserted frenula. While effective, scalpel-based frenectomy may involve longer healing due to incision-related discomfort.

Electrocautery and laser-based techniques offer alternatives. Electrocautery excises the frenum while coagulating blood vessels, reducing intraoperative bleeding. However, excessive heat can delay healing if not carefully controlled.

Laser frenectomy, using diode, CO₂, or erbium lasers, provides a minimally invasive option with reduced post-operative discomfort. The laser ablates fibrous tissue while promoting hemostasis, often eliminating the need for sutures. Research in Lasers in Medical Science indicates laser frenectomy results in lower post-operative pain and faster healing compared to scalpel techniques, particularly in pediatric patients. The precision of laser technology allows selective tissue removal while preserving adjacent structures.

Post Surgical Healing

Healing unfolds in stages, starting with fibrin clot formation at the surgical site. This clot acts as a temporary matrix for epithelial migration, sealing the wound within 24 to 48 hours. Mild swelling and localized discomfort are common, particularly with scalpel-based procedures where sutures may create additional tension. Patients often report a stretching sensation when moving their upper lip, which diminishes as healing progresses. Over-the-counter analgesics like ibuprofen or acetaminophen typically manage pain, though laser frenectomy patients often experience less discomfort due to reduced collateral tissue damage.

Within the first week, granulation tissue replaces the fibrin clot, marking early wound healing. Fibroblast activity increases, leading to collagen deposition and tissue restoration. Oral hygiene is crucial to prevent infection, with saline or chlorhexidine rinses recommended. Avoiding acidic or spicy foods minimizes irritation, while prescribed stretching exercises prevent frenum reattachment, especially in pediatric patients.

Pediatric Considerations

For younger patients, frenectomy decisions are influenced by feeding difficulties, speech development, and orthodontic concerns. Infants with a restrictive frenum may struggle with breastfeeding due to impaired latch, leading to poor weight gain and maternal discomfort. While some cases resolve naturally, persistent restrictions may require early intervention. Pediatricians and lactation consultants assess severity using classification systems like the Coryllos or Kotlow scale, which categorize frenal attachments by insertion point and functional impact. Early laser release has been linked to improved feeding and minimal post-operative distress, making it a preferred option for neonates and infants.

Beyond infancy, frenectomy may be considered for speech articulation difficulties or dental concerns. While not all restrictive frenula affect speech, cases with significant lip mobility limitations can impact bilabial sound production. Speech-language pathologists and dental specialists collaborate to determine if surgery is necessary. In children undergoing early orthodontic assessment, a high frenum attachment may contribute to persistent diastema. The procedure is often coordinated with orthodontic treatment to optimize spacing and tooth stability. Pediatric soft tissues heal rapidly, and post-operative stretching exercises help prevent reattachment.

Orthodontic Perspectives

In orthodontics, frenectomy is often performed to address structural limitations affecting dental alignment and periodontal health. A common indication is midline diastema, where a thick or low-inserting frenum creates tension between central incisors, preventing natural closure. Orthodontists evaluate whether the frenum is a primary factor, as some diastemas close spontaneously with permanent canine eruption. When frenal tension persists despite orthodontic treatment, surgical removal may be necessary to eliminate mechanical resistance and ensure stable tooth positioning. Research in the American Journal of Orthodontics and Dentofacial Orthopedics suggests frenectomy after orthodontic space closure reduces relapse risk by minimizing forces that could reopen the gap.

An abnormal frenum can also contribute to gingival recession by exerting continuous tension on gum tissue, particularly in patients with thin periodontal biotypes. This increases the risk of attachment loss, especially when orthodontic treatment involves significant tooth movement. In such cases, frenectomy may be performed alongside periodontal procedures to preserve gingival integrity. Timing is crucial—performing the procedure too early may result in scar tissue complicating orthodontic adjustments. Many clinicians delay frenectomy until after active orthodontic treatment to ensure final tooth positioning is stable before addressing soft tissue concerns.