A frenum (or frenulum) is a small band of soft tissue that connects two parts of the mouth. While a normal part of oral anatomy, sometimes this tissue is unusually short, tight, or thick. When a frenum restricts movement or causes problems, a simple surgical procedure called a frenectomy is performed to release or modify the tissue. Frenectomies are common procedures performed on patients of all ages to restore normal function. The two most common types are distinguished by their location: the lingual frenectomy and the labial frenectomy.
Lingual Frenectomy The Tongue Tie Procedure
The lingual frenum connects the underside of the tongue to the floor of the mouth. When this tissue is too short or restrictive, the condition is known as ankyloglossia, or “tongue tie.” This restriction limits the tongue’s mobility, particularly its ability to lift and move forward, causing problems related to feeding and speech development.
In infants, a tight lingual frenum prevents the tongue from achieving a proper seal and latch during breastfeeding. This difficulty leads to ineffective milk transfer, poor weight gain for the baby, and pain for the nursing parent. The child may be unable to properly manipulate the tongue to create the necessary suction for feeding. The procedure can be performed shortly after birth to address these immediate functional challenges.
In older children and adults, a restricted lingual frenum interferes with the articulation of certain speech sounds, specifically those that require the tongue to touch the roof of the mouth or the upper gums, such as “l,” “r,” “t,” “d,” and “s” sounds. Restricted movement also makes it difficult to swallow efficiently and sweep food debris from the teeth, impacting oral hygiene. Releasing the frenum allows the tongue a greater range of motion, significantly improving these functions.
Labial Frenectomy The Lip Tie Procedure
The labial frenum connects the center of the lip (upper or lower) to the gum tissue between the two front teeth. The upper labial frenum is most frequently addressed; when it is thick or extends too far down, it is sometimes called a “lip tie.” Unlike the lingual frenum, the primary concerns associated with a restrictive labial frenum relate to dental health and tooth positioning.
A low-hanging labial frenum physically pulls on the gum tissue attached to the front teeth, potentially causing gum recession over time. This recession exposes the tooth roots, making them susceptible to sensitivity and periodontal issues. Furthermore, the tension may make proper brushing difficult, leading to plaque accumulation and an increased risk of decay.
A thick or low labial frenum can create or maintain a significant gap, known as a diastema, between the upper front teeth. This tissue can impede orthodontic treatment later in life. A labial frenectomy is often performed before or during orthodontics to allow the gap to close successfully and reduce the risk of it reopening after treatment.
Comparing Surgical Techniques and Execution
Both lingual and labial frenectomies involve a straightforward process to release the restrictive tissue. The choice of technique depends on the patient’s age and the frenum’s thickness, ranging from traditional surgical approaches to modern technology. Traditional frenectomies use a scalpel or surgical scissors to excise the tissue, often requiring absorbable sutures to close the wound. This method is effective but may involve slightly more bleeding and a longer procedure time.
Modern techniques frequently employ a soft-tissue laser, such as a CO2 laser, to perform the procedure. The laser vaporizes the restrictive tissue while simultaneously cauterizing blood vessels, resulting in minimal to no bleeding. Laser use often eliminates the need for sutures and reduces post-operative swelling and discomfort, leading to a quicker procedure.
In cases involving a broad or thick labial frenum, the surgeon may use a more complex technique, such as Z-plasty. This method involves making small, specific incisions to reshape the tissue, which helps minimize the chance of scar tissue formation. The technique is carefully chosen to ensure the best functional and aesthetic outcome.
Recovery Protocols and Expected Long Term Outcomes
Recovery from both types of frenectomies is typically quick, as the procedure is outpatient and often requires only local anesthesia. Patients, including infants, can usually resume normal activities and feeding almost immediately. A soft, cool diet is recommended for the first 24 to 48 hours to prevent irritation, and mild discomfort is managed with over-the-counter pain relievers.
The most critical component of post-operative care involves wound management or stretching exercises, necessary for both lingual and labial releases. These exercises gently stretch the surgical site multiple times a day for several weeks to prevent the tissue from healing back together, a process known as reattachment. For infants, these exercises are often combined with specific suck training to help them use their newly freed tongue effectively.
The long-term outcomes are highly positive when post-operative protocols are followed diligently. Success following a lingual frenectomy is measured by improved function, such as a more effective latch for infants and clearer speech articulation for older patients. For a labial frenectomy, expected results include reduced tension on the gumline to prevent future recession and the successful closure of any pre-existing gap between the front teeth, often alongside orthodontic care.