A frenum (or frenulum) is a small band of soft tissue connecting two parts of the body; the oral cavity contains several of these structures. A frenectomy is a minor surgical procedure involving the alteration or removal of a frenum. This intervention is common in pediatric medicine and dentistry when a frenum restricts normal function. When an oral frenum is abnormally tight or short, it can interfere with developmental milestones in infants and children. The goal is to release the restricting tissue to restore a full range of motion and functional capacity.
Anatomy and Identifying Oral Ties
Two primary frena are involved in pediatric frenectomies: the lingual frenum, located beneath the tongue, and the labial frenum, connecting the upper or lower lip to the gums. The lingual frenum stabilizes and supports the tongue, which is necessary for sucking, swallowing, and speech. When this tissue is restrictive, the condition is called ankyloglossia, or a “tongue tie.”
A restrictive lingual frenum prevents the tongue from lifting to the palate or moving forward adequately, impairing the ability to create a proper seal during breastfeeding. This limitation forces the child to use compensatory muscles, leading to fatigue and inefficient feeding. The labial frenum connects the lip to the gum tissue, and a short or thick attachment is commonly referred to as a “lip tie.”
A restrictive labial frenum prevents the lip from flanging outward during feeding, making it difficult to maintain suction on the breast or bottle. Beyond infant feeding issues, an overly tight upper labial frenum may contribute to a gap between the front teeth or interfere with proper oral hygiene later in childhood. Both conditions are defined by the functional limitation they impose, not merely the visual presence of the tissue band.
Pediatric Assessment and Treatment Decision
The decision to perform a frenectomy focuses on functional impairment, not merely the anatomical appearance of the frenum. A comprehensive assessment typically involves a team of pediatric professionals, including pediatricians, dentists, and lactation consultants. These specialists look for specific symptoms indicating a functional problem, such as failure to thrive in infants, maternal pain during nursing, or delayed speech in older children.
Assessment tools, such as the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF), are used to evaluate both the appearance and the function of the tongue. A low score on the functional portion suggests that the range of motion is significantly limited, which may warrant intervention. For older children, a restricted frenum may contribute to speech sound difficulties, messy eating, or sleep disturbances.
Before moving to a surgical solution, conservative management strategies are explored to see if function can be improved without intervention. These may include working with a lactation consultant to improve the feeding latch or performing gentle stretching exercises designed to increase the tissue’s flexibility. A frenectomy is reserved for cases where non-surgical efforts do not resolve the functional issues, or when the restriction is severe enough to cause significant problems. The procedure is most commonly performed during infancy when the frenum tissue is thinner and healing is fast.
The Frenectomy Procedure and Techniques
The frenectomy is a swift, in-office procedure performed with minimal discomfort, especially in infants. The goal is to release the restrictive tissue to allow for full mobility of the tongue or lip. Two main techniques are used for this minor surgery: the traditional scalpel or scissors method and the soft tissue laser method.
The conventional surgical technique involves using a scalpel or sterile surgical scissors to make a precise incision to release the frenum. This method often requires sutures to close the wound, especially if the tissue is thick or vascular. While effective, the conventional approach can result in more post-operative bleeding and may require a longer healing time compared to laser methods.
The soft tissue laser technique, commonly using a CO2 or diode laser, has become popular in pediatric frenectomies. The laser excises the tissue while simultaneously cauterizing the blood vessels, resulting in minimal to no bleeding during the procedure. This cauterizing action reduces the risk of infection and often eliminates the need for sutures, contributing to less post-operative pain and a faster recovery. Regardless of the technique used, the procedure creates a diamond-shaped wound that must be managed carefully during healing.
Post-Procedure Healing and Necessary Follow-Up Therapy
The immediate post-operative period is crucial for ensuring a successful outcome, with the primary concern being preventing reattachment of the released tissue. The wound site typically forms a white or yellow “wet scab” during the first few days of healing. Parents are instructed on pain management, which may include acetaminophen or applying agents like frozen breast milk, as the baby may be fussy for up to three days.
The most important part of aftercare involves a regimen of post-frenectomy exercises, often referred to as “stretches,” which must be performed frequently. These exercises are designed to keep the surgically created diamond-shaped wound open and prevent the raw surfaces from fusing. The stretches are typically performed multiple times a day for several weeks, and consistency is necessary to maintain the new range of motion.
The frenectomy is often just the initial step; ultimate success relies on follow-up therapy to address muscle memory and compensatory habits. Infants require continued support from a lactation consultant to learn how to use their newly mobile tongue and achieve an effective latch. Older children may benefit from bodywork or speech therapy to retrain the tongue and facial muscles to utilize the full range of motion for proper function, chewing, and speech.