A frenectomy is a minor surgical procedure involving the removal or modification of a frenum, a small fold of tissue connecting two parts of the mouth. This procedure releases restrictive tissue, restoring normal movement and function to the tongue or lip. It is performed on infants, children, and adults when a frenum is abnormally tight, short, or thick. The treatment is quick and simple, addressing functional problems that impact feeding, speech, or dental development.
Understanding the Frenum and Common Issues
The mouth contains several folds of connective tissue called frena; the most commonly treated are the lingual and labial frenum. The lingual frenum connects the underside of the tongue to the floor of the mouth, and the labial frenum attaches the inside of the upper or lower lip to the gum tissue. When these tissues restrict movement, the condition is informally called a “tie.” A restrictive lingual frenum, known as ankyloglossia or tongue tie, limits the tongue’s mobility, making it difficult to lift or move from side to side.
For infants, this restriction interferes with feeding, often leading to a shallow latch during breastfeeding. This results in inadequate milk transfer for the baby and can cause painful or damaged nipples for the nursing parent. Ankyloglossia also affects older children and adults, contributing to difficulties with speech articulation, especially sounds requiring the tongue to reach the upper palate. A restrictive labial frenum, or lip tie, prevents the upper lip from flaring out properly, making it challenging for a baby to create a strong seal on the breast or bottle. In adults, an overly tight labial frenum can pull on the gum tissue, leading to gum recession or creating a noticeable gap between the two front teeth. The decision to perform a frenectomy is based on the functional limitation the tie causes rather than appearance alone.
The Frenectomy Procedure
The frenectomy is performed in a dental or medical office setting, with the actual surgical time often lasting only a few minutes. The area is first numbed with a local anesthetic. This may be a topical gel or a small injection, especially for older patients, though a topical numbing agent is often sufficient for infants.
There are two primary methods for performing the procedure: the traditional surgical approach and the modern laser method. The conventional technique uses a scalpel or surgical scissors to release the restrictive tissue. This method often requires stitches to close the wound, which can prolong healing time and increase post-operative discomfort.
The laser frenectomy, often using a CO2 laser, is increasingly preferred. The laser uses a concentrated beam of light to precisely remove the tissue while simultaneously sealing blood vessels and nerve endings. This results in minimal bleeding and reduced discomfort during and after the procedure. Because the laser cauterizes the tissue, stitches are typically not necessary, simplifying the process and contributing to a faster recovery.
Recovery and Post-Operative Care
Immediate post-operative care focuses on minimizing discomfort and encouraging the patient to use the newly freed tissue. Discomfort is generally mild and can be managed with over-the-counter pain relievers, as recommended by the practitioner. In the days following the procedure, the wound site typically develops a white or yellowish patch, which is a normal protective layer and not a sign of infection.
The most important part of healing involves specific wound management exercises, often called stretches. These stretches prevent the tissue from reattaching or healing too tightly, which would negate the surgery’s benefits. The exercises involve gently manipulating the released area multiple times a day for several weeks, commonly three to six weeks. Since the mouth heals quickly, intervention is necessary to prevent scar tissue from restricting movement again. For a lingual frenectomy, the tongue is gently lifted to keep the surgical site open; for a labial frenectomy, the lip is lifted high toward the nose. Adherence to this post-operative protocol ensures a successful, long-term outcome with maximum mobility.