A frenum is a small fold of soft tissue that naturally connects two parts of the mouth. While this band of tissue is a normal anatomical structure, if it is unusually thick, short, or tight, it can restrict movement, leading to functional difficulties. A frenectomy is the surgical procedure performed to release or remove this restrictive band of tissue. It is a common procedure performed on infants, children, and adults to improve oral function, though the reason for intervention depends on the specific location of the restrictive frenum.
Lingual Frenectomy (Tongue-Tie)
A lingual frenectomy addresses the lingual frenum, which is the tissue band anchoring the underside of the tongue to the floor of the mouth. When this frenum is too short, the condition is known as ankyloglossia, or tongue-tie, which limits the tongue’s mobility. For infants, a restricted lingual frenum often results in significant feeding difficulties, as the tongue cannot elevate or extend properly to create an effective suction seal during nursing. This inability to latch deeply can lead to poor weight gain for the baby and considerable nipple pain for the nursing parent.
Beyond infancy, an untreated tongue-tie can manifest as difficulties in speech articulation, particularly with sounds that require precise tongue placement (e.g., ‘l,’ ‘r,’ ‘t,’ ‘d,’ ‘n,’ and ‘s’). Older children and adults may also find it challenging to move food around the mouth effectively for chewing and swallowing. A tight lingual frenum restricts the tongue’s ability to sweep the mouth clean, which can contribute to poor oral hygiene and an increased risk of dental decay. The primary goal of a lingual frenectomy is to restore the full range of motion.
Labial Frenectomy (Lip-Tie)
The labial frenectomy is performed on the labial frenum, the fold of tissue that connects the inner side of the upper lip to the gum line, typically just above the two upper front teeth. A restrictive upper labial frenum can prevent the lip from flanging outward properly, which is necessary for a deep latch during breastfeeding in infants. This restriction primarily interferes with the seal, leading to shallow sucking and often the intake of excess air. While the effect on infant feeding may be less pronounced than a severe tongue-tie, it can still contribute to inefficiency.
In older children, a prominent labial frenum is often associated with dental concerns. If the tissue attaches too low on the gums, it can pull on the gum line, potentially leading to gum recession over time. The most visually noticeable effect is the creation or maintenance of a significant gap, known as a diastema, between the upper central incisors. For this reason, a labial frenectomy is often recommended later in childhood, typically between the ages of 8 and 11, after the permanent canines and incisors have erupted.
Differences in Procedure and Post-Operative Care
The technical approach to a frenectomy varies, but the procedure is generally quick regardless of the location. Traditional methods involve using a scalpel or surgical scissors to release the restrictive tissue. Increasingly, soft tissue lasers are employed for both lingual and labial frenectomies, which offer high precision and minimize bleeding because the laser cauterizes the tissue as it cuts. Laser use can also potentially reduce discomfort and speed up the initial healing process.
The most significant difference lies in the post-operative care, which is specifically designed to prevent reattachment of the released tissue. Following a lingual frenectomy, parents must perform active stretching exercises several times a day to ensure the tongue’s new mobility is maintained. These stretches involve lifting and extending the tongue to prevent the wound from healing back together in a restricted position. The movements are focused on the base and underside of the tongue.
For a labial frenectomy, the post-operative stretching focuses on lifting the lip high up toward the nose to keep the surgical site open. This movement is simpler but equally necessary to stop the lip from adhering back down to the gums. Recovery from both procedures usually involves a period of minor discomfort managed with over-the-counter pain relievers. Adherence to the specific stretching protocol is paramount to the long-term success of either procedure.