A frenectomy is a minor surgical procedure designed to address restricted movement in the mouth caused by small bands of connective tissue called frenulums. This procedure involves releasing, or sometimes removing, this tissue to restore a full range of motion to the tongue or lip. It is a common intervention, particularly for infants and young children, when the restrictive tissue interferes with normal oral functions. When a frenulum is unusually short, thick, or tight, it can impede activities ranging from feeding to speaking. Addressing this restriction early can help prevent issues that affect a child’s development and oral health.
Anatomy and Conditions Requiring the Procedure
The mouth contains several frenulums, which are thin folds of mucous membrane that anchor mobile parts of the mouth. The two most commonly associated with a need for surgical release are the lingual frenulum and the labial frenum. The lingual frenulum connects the underside of the tongue to the floor of the mouth, while the labial frenum connects the inside of the upper or lower lip to the gum tissue.
A restrictive lingual frenulum leads to a condition known as ankyloglossia, or “tongue tie.” This structural variation limits the tongue’s ability to move upward, forward, and side-to-side, which is necessary for proper oral function. The severity of the restriction is determined by how much the tissue tethers the tongue, not just the frenulum’s appearance.
Similarly, a restrictive labial frenum, often called a “lip tie,” is a band of tissue that limits the upper lip’s ability to move freely. A tight upper labial frenum may pull the lip down and prevent it from flanging outward. This restriction can cause tension on the gumline, potentially leading to long-term dental and functional concerns.
Functional Problems Caused by Ties
The primary reason a frenectomy is recommended for infants is to resolve feeding difficulties, particularly with breastfeeding. A tongue tie can prevent a baby from achieving a deep, effective latch because the tongue cannot elevate or extend sufficiently to cup the breast. This ineffective suckling can lead to the infant swallowing excessive air, resulting in symptoms like gas, colic, and excessive spitting up.
For the nursing parent, the shallow latch often causes significant nipple pain, trauma, or bleeding, as the baby compensates by chomping down rather than sucking effectively. This poor milk transfer can also lead to maternal complications, including recurrent plugged ducts or mastitis, and may lead to a premature end to the breastfeeding relationship. In infants, the most pressing concern is often poor weight gain or failure to thrive due to inefficient feeding.
As children grow, untreated tongue or lip restrictions can cause a different set of functional challenges. The inability to move the tongue adequately can interfere with speech articulation, making it difficult to produce sounds that require the tongue to touch the roof of the mouth, such as the letters ‘l’, ‘r’, ‘t’, ‘d’, and ‘n’. This can sometimes lead to speech delays or the need for extensive speech therapy.
Beyond speech, a restricted tongue can impede the ability to clear food debris from the teeth and palate, contributing to poor oral hygiene. This lack of tongue mobility may also affect the transition to solid foods, resulting in difficulties chewing age-appropriate textures, gagging, or being an overly picky eater. In the long term, a persistently tight labial frenum can contribute to a significant gap between the upper front teeth or cause the gum tissue to recede due to excessive tension on the gums.
Surgical Methods and Post-Procedure Care
The frenectomy procedure is a quick and relatively simple process, often performed in a dental or medical office setting. Traditional methods involve using sterile scissors or a scalpel to precisely snip the restrictive tissue, a technique known as a frenotomy. This method is fast but may require sutures and typically involves a small amount of bleeding.
Many practitioners now utilize a soft-tissue laser for the release, often referred to as a laser frenectomy. The laser ablates the tissue with high precision, which seals the blood vessels and nerve endings simultaneously. This hemostatic action minimizes bleeding, reduces the risk of infection, and often eliminates the need for stitches, leading to a faster healing process with less discomfort immediately following the procedure.
Regardless of the method used, the most important component of the treatment is the post-operative care, which is designed to prevent the two raw surgical sites from reattaching. This healing process, known as secondary intention, requires meticulous wound management in the first few weeks. Parents are instructed to perform specific stretching and massage exercises several times a day for a period of two to four weeks.
These stretches involve gently lifting the lip or tongue to maintain the newly created range of motion and prevent the wound from healing back together. For a lingual frenectomy, this usually means lifting the tongue toward the roof of the mouth to stretch the diamond-shaped surgical site. For a labial frenectomy, the lip is pulled high toward the nose to stretch the upper gum area. Consistent and correct execution of these wound exercises is directly linked to the success of the procedure and the prevention of scar tissue formation.