What is trimming the frenulum of the upper lip and why is plastic surgery necessary? Trimming the short frenulum of a child's tongue.

Such anatomical formations are the thinnest folds of the mucous membrane that connect the mobile lips and tongue with the fixed parts of the oral cavity: the gums and the sublingual space.

In total, there are three frenulums in the baby’s mouth:

1. Tongue - located under the tongue.
2. Upper lip - localized between the upper lip and the gum mucosa above the level of the central incisors.
3. Lower lip - connects the inner surface of the lower lip with the gums at the level of the middle of the alveolar process on the lower jaw.

Despite their small size, such mucous folds have great value in a person's life. In a newborn, they are responsible for proper attachment to the mother's nipple. In older children, the frenulum is involved in the correct pronunciation of sounds and in the formation of a normal bite.

In the photo: a short frenulum of the tongue in a child

Short frenulum and why it is dangerous

Shortening of the frenulum is understood as a decrease in its absolute length or its incorrect location, which makes it relatively short (i.e., the length remains normal, but its incorrect localization causes all the symptoms characteristic of shortening).

A short frenulum of the upper or lower lip in a baby can negatively affect the process of breastfeeding. In this case, the child cannot correctly position the nipple in the mouth and create a sufficient vacuum necessary for sucking and swallowing. Therefore, in order to get enough, the baby has to make significant efforts. The baby quickly gets tired and stops breastfeeding without being properly satisfied. Such children behave restlessly, require frequent breastfeeding, but do not gain weight well.

In children over 3 years old, a shortened upper frenulum can cause an increase in the interdental spaces between the upper incisors and their advancement sharply anteriorly. A short lower labial frenulum sometimes causes malocclusion.

Also, a decrease in size or incorrect location of any of them can have an extremely negative impact on speech function. Children 2 years of age who have not had this pathology diagnosed or corrected in time often do not speak individual sounds. Such speech defects are difficult to correct.

How to check a child's frenulum?

A shortened frenulum between the lip and gum is diagnosed quite simply even in infants. To do this, you need to carefully pull back the child’s lips and see how pronounced the fold of the mucous membrane is and where it is attached. If it is short, then it will have a thick appearance and its attachment point will be at the very base of the incisors.

The hyoid frenulum normally has a length of at least 8 mm and is attached approximately halfway between the root and tip of the tongue. A small frenulum usually looks like a fold on the mucous membrane, attached along its entire length to the tongue or sublingual space.

In the photo: short bridle upper lip in a newborn

How to stretch

It is necessary to immediately make a reservation that, due to anatomical features, only the frenulum under the tongue can be stretched without surgery. This technique is usually taught by a speech therapist and is effective only if all recommendations are carefully followed over the course of several months.

Before performing any exercises, it is recommended to do a special massage to stretch the soft tissues. To do this, you need to carefully take the tongue by the very tip and with gentle movements move it upward, then to the sides and pull it forward a little. Gentle stroking from bottom to top along the frenulum using the thumb and index finger has a good effect.

The exercises themselves are performed sequentially twice a day:

1. Relax your tongue as much as possible and place it on your lower lip. Hold for 10 seconds in 3 sets.
2. Stick your tongue out of your mouth as far as possible. Fix in this position for 10 seconds. Repeat 3 times.
3. Extend your tongue and circle your lips with it.
4. Click your tongue for 10 seconds, imitating the clatter of horse hooves.
5. Open your mouth wide. Slowly run the tip of your tongue across the roof of your mouth, moving from your teeth to your throat.
6. Place your tongue on the roof of your mouth just behind your teeth. Holding it in this position, open your mouth as wide as possible.

Such fairly simple exercises help both stretch the frenulum on the tongue and correct some speech defects.

Surgical correction

If a short frenulum is detected in the maternity hospital, then its trimming is carried out immediately. This is done so that the baby can properly take the nipple and eat properly. If shortening is diagnosed at an older age and is not corrected by speech therapy techniques, then three options are possible surgical treatment:

• Frenotomy is cutting to increase its length.
• Frenectomy is a circumcision when it is almost completely excised.
• Frenuloplasty is a plastic surgery during which the place of its attachment in the mouth is changed.

In the photo: a child’s tongue frenulum after laser surgery

Despite the fact that frenulum surgery itself is quite common, most parents have large number questions about this procedure. We will consider the main ones below.

Why trim?

A too small size of such a fold of the mucous membrane can cause difficulty sucking at the breast in infants, and problems with the pronunciation of certain sounds and with the arrangement of teeth in the permanent dentition in older children. To avoid such problems, pruning is required.

Do I need to prune?

Most doctors, including the famous Dr. Komarovsky, are unanimous in the opinion that a short frenulum should be trimmed if it adversely affects the child’s ability to suck milk or pronounce certain sounds.

When a short frenulum does not negatively affect the processes of sound production and bite formation, then in such cases surgical intervention is not required.

What kind of doctor cuts?

Typically, frenulum correction operations are the responsibility of a dentist.

At what age is it best to have surgery?

When the frenulum should be trimmed is decided individually for each child. If we are talking about a fold on the upper lip, then correction is done no earlier than 6 years. Typically, the operation is performed only after the eruption of the permanent upper incisors. If correction is required on the lower lip, this is done more often after the 4th year of life.

In most cases, the hyoid frenulum is cut before 1 year of age (most often this is done in the maternity hospital). But correction is possible at any age.

How do they prune?

The frenulum trimming operation is performed on an outpatient basis in the surgical office of a dental clinic. The doctor carefully stretches the fold of the mucous membrane and makes a small incision with a sharp scalpel. After that, small sutures made of threads are applied to the edges, which after some time dissolve on their own and do not need to be removed.

A more modern technique is laser dissection, which eliminates the need for stitches, which speeds up the child’s recovery process.

Does it hurt to prune?

The dissection procedure is performed under local anesthesia, which eliminates the possibility of any pain.

What to do if a child breaks the frenulum

Children at any age are quite active and mobile. Therefore, injuries are inevitable. Quite often, parents turn to the dentist with the following problem: the baby fell unsuccessfully and tore the frenulum above the upper lip or under the tongue. At the same time, damage to the lower lip is extremely rare due to the fact that normally it is almost not expressed.

If a child cuts the frenulum, then the following signs will be characteristic of such an injury:

• Swelling of the soft tissues in the mouth and above the lip (if the child has torn the upper lip).
• Quite profuse bleeding.
• Pain in the mouth when talking or eating.

In any case, if the baby has torn the mucous fold under the upper lip or under the tongue, you should immediately consult a doctor. It is he who will decide whether such a gap needs to be sutured and will carry out the necessary procedures. Self-treatment can lead to negative consequences: the tissues will not grow together correctly with the formation of rough scars, which will subsequently lead to an incorrect bite and unclear pronunciation of sounds.

topdent.ru

Causes of short frenulum of the tongue in children

In most cases, the pathology of the frenulum of the tongue of infants arises from the influence of a hereditary factor. If one of the parents had such a problem in early childhood, then there is a high probability that the baby will have a shortened sublingual cord. But other causes of congenital ankyloglossia have also been proven. What factors provoke the development of anomalies during intrauterine development of the fetus?

• The process of formation of the tongue cord is influenced by the behavior of the mother during pregnancy and its course itself. Early toxicosis, taking antibiotics, hormonal drugs, especially in the first or last trimester of intrauterine development, often lead to the occurrence of the described fetal pathology.
• Abdominal injuries, infections during fetal formation, late age of women in labor (after 40 years), poor environmental conditions, stressful conditions, and persistent depression are the main causes of shortened oral membranes in newborns.

Signs of a short frenulum of the tongue in infants

Without the participation of the tongue, the baby’s full sucking function is impossible. The mobility of the tongue and the normal development of the oral organs ensure optimal nutrition, which means the development and growth of the baby. If the cord that attaches the tongue to the mucous membrane of the lower palate of the oral cavity is greatly shortened, the child experiences some discomfort while sucking milk from the mother's breast. He is unable to lick his lips, and the very extraction of milk causes irritation and pain.

The mother experiences unpleasant, even painful sensations when the baby grasps the breast incorrectly: the baby presses only the nipple, and not the areola, since the functionality of the lower jaw is limited. As a rule, most of the milk pours out of the baby's mouth, after which the baby becomes capricious, refusing to eat. In this case, the young mother does not know how to help the baby and begins to panic.

Symptoms and consequences

Each mother is able to independently discern whether a newborn has a shortened frenulum. In most cases, the dentist indicates the existence of a problem, but this is also done by an experienced pediatrician. Let's consider the main symptoms of ankyloglossia in infants:

• When feeding, the baby “smacks” a lot,
• often bites the nipple of the breast until the mother experiences pain,
• requires frequent breastfeeding,
• the baby is nervous, often throws the nipple, does not eat enough,
• refuses to draw milk because this action causes him pain, discomfort,
• does not gain enough weight due to constant malnutrition.

If parents do not notice the pathology, as the child grows up, the risk of serious complications increases: improper formation of teeth, periodontitis, gingivitis. The short strand has negative impact for the entire articulatory apparatus. The child is developmentally delayed compared to his peers, cannot pronounce certain sounds, and his speech is distorted due to limited mobility of the lower jaw. If you waste time, then after 5 years, even after undergoing surgery, cutting the cord will not be effective; the person will never learn to pronounce certain sounds correctly.

How to check a child's frenulum

The length of the bridge in an infant should be at least 8 mm, in an adult - 2-3 cm. A short frenulum of the tongue of a newborn is easy to diagnose visually. To do this, pull back the child’s lower lip and let him open his mouth. This way you will see where the bridge is attached and how close it is to the row of future teeth. If the frenulum holds the tongue almost at its very tip, and the tip of the tongue barely touches the lips, then this is a sure sign of an anomaly of the hyoid cord. Look at the shape of the tongue: if a child cries, then the boat shape also indicates a congenital anomaly.

It is much easier to diagnose a shortened bridge in older children - 2-3 years old, when the baby is already learning to reproduce words. Often, incorrect pronunciation of certain sounds forces parents to turn to a speech therapist. The specialist often confronts the patient with a fact – congenital pathology of the cord or ankyloglossia. But this is not a disease, but a temporary condition of the mucous membrane, and the problem is completely solvable. This bridge can be stretched using a special massage, articulation exercises, as well as surgical intervention.

Treatment of frenulum under the tongue in newborns

Congenital anomaly of the sublingual bridge is resolved in two ways: stretching the small cord with articulation exercises, as well as surgical intervention. For infants, another more acceptable method is trimming with scissors or a laser. It’s good if the doctor sees the problem and solves it during childbirth. Otherwise, everything depends on the parents’ attention to the health of their children and timely access to qualified medical assistance. If the bridge is slightly shorter than normal, and the baby takes the breast normally, then surgical intervention is not required.

Bridle cutting in babies

The sublingual cord is trimmed in the first weeks of the baby’s life, since later the oral organ becomes more susceptible to surgical intervention or laser plastic surgery. This is explained by the fact that the blood vessels are located deep, closer to the far end of the cord, which is adjacent to the root of the tongue. Mother’s milk will help calm the baby after such a procedure: a few drops will quickly heal the wound. As a result of surgical treatment, no complications arise, and the trimmed bridge allows the articulatory apparatus to develop correctly.

The operation should not frighten parents. The surgical intervention takes only a few minutes, the child does not need anesthesia (anesthesia): he does not hurt, there is no visible bleeding. This is explained by the still unformed nerve endings in the tissues of the gum mucosa and sublingual cavity. After a day, the small incision heals, the baby develops normally and gains weight. The threads with which the incision was sewn will dissolve, and the microscopic suture will not interfere with the child.

When is the best time to have surgery?

The operation is best performed before the child is one year old. During a routine examination of the baby, the pediatrician’s task is to promptly recognize the cause of the baby’s anxiety and prescribe appropriate treatment. If time is lost and parents see a defect in the bridge after 3 years, you need to contact an orthodontist or pediatric surgeon. When the child is 5 years old or older, the surgeon explains that the operation is inadvisable, since the child has already developed the skills to pronounce the scale. Even a good outcome of the operation does not mean that the child will not have a lisp in the future.

Photo - tongue frenulum in newborns

We present to your attention a selection of photos that demonstrate a congenital anomaly of the frenulum under the tongue. If you suspect that your baby has the same problem, make sure of this by comparing the picture in the baby's oral cavity with the attached images of typical pathologies. Ankyloglossia is shown here, which is expressed to a greater or lesser extent, depending on the location of attachment on the lower gum.

mosmama.ru

Difficulties associated with a short frenulum

Every person has a frenulum in their mouth. In appearance, these are thin folds of the mucous membrane that connect the moving parts of the oral cavity (lips and tongue) with the fixed ones (gums and the space under the tongue). There are three of them in total: one is located directly under the tongue, the other two are connected to the upper and lower lips, respectively.

When they talk about a shortened frenulum, they mean either its short length or its incorrect location (the length is normal, but locally it is attached in such a way that it keeps the tongue “on a short leash”). In medicine, the defect is called ankyloglossia or congenital pathology of the cord.

The first difficulty is that the correct process of grasping and sucking the breast is disrupted. After all, normally, when latching onto the breast, the baby’s mouth is wide open, so that the lower lip turns outward, and the tongue itself is located on the gum of the lower jaw. As a result, the nipple areola is completely captured, the necessary vacuum is created, and the tongue begins to work.

A short frenulum does not allow the nipple to be properly grasped, and the baby quickly gets tired while eating. By giving up the breast prematurely, he does not receive adequate nutrition, gains weight worse, is restless during feeding and requires frequent feeding.

Another problem becomes obvious closer to 2 years, when the child experiences speech disorders. The baby cannot pronounce individual sounds and has to work hard to eliminate such defects. A shortened frenulum of the lower lip provokes the formation of an abnormal bite.

Causes and symptoms

A short fold is formed during intrauterine development in the presence of pregnancy pathologies. However, most often its small size is explained by genetic predisposition. That is, when close relatives had similar problems, the likelihood of a frenulum correction in the heir increases.

Symptoms that may indicate that something is wrong with the sublingual fold are the following:

• the child “hangs” at the breast for more than 30 minutes, but does not eat enough;
• does not gain weight well;
• the baby smacks his lips while eating, bites the nipple with his gums, or cannot hold it in his mouth for a long time;
• often burps, he is tormented by flatulence (a consequence of air ingress);
• milk stagnates in the breast.

At an older age, ankyloglossia causes the following problems:

• speech defects;
• formation of malocclusion;
• early onset of caries (in case of frenulum defect above the upper or lower lip);
• formation of crooked teeth;
• excessive drooling;
• difficulty sleeping, sleep apnea.

Diagnostics

The hyoid frenulum is easy to check. Normally, it is attached somewhere in the middle between the root and the tip of the tongue, and its length is at least 8 mm. Professor Alison Haselbaker has developed a special test that takes into account the ability of the tongue to stretch forward, rise to the upper palate, and turn in different sides, the sucking reflex is assessed, how elastic the frenulum is, etc.

Visually, with ankyloglossia, the tongue takes on a heart shape due to a fold pulling from below. This is clearly visible when crying. If you stick your tongue out to your baby, he won't be able to copy you and do the same.

Trim or stretch?

If the defect under discussion is diagnosed, there are two ways to eliminate it:

• try to stretch the frenulum with the help of special exercises;
• trim it.

To be fair, it should be said that you can do without surgical intervention and try to stretch only the hyoid frenulum, provided that the child is already able to independently perform the necessary exercises under the supervision of an adult. The stretching technique is usually taught by a speech therapist, and the exercises are done at least twice a day for several months.

However, such procedures are not suitable for a newborn. And if we are talking about the possibility of further normal breastfeeding, it is better to agree to trimming. As we will see later, no negative consequences Such an operation has no health benefits.

When to prune?

How do you know when is the best time to trim your bridle? If the problem was noticed immediately after birth, pruning will be offered right in the maternity hospital in order to forget about further unpleasant consequences once and for all.

If the child is more than 9 months old, it means that there are no difficulties with feeding, and the frenulum does not bring any particular inconvenience. Therefore, it makes sense to wait until the child speaks. Perhaps the tongue frenulum will not affect the baby's speech ability in any way, or it will stretch. In principle, correction with surgery can be performed at any age. Only the older the patient, the greater the likelihood that it will be necessary to use anesthesia (though in the vast majority of cases, local) and sutures.

In addition, at school age, when a speech therapist or orthodontist refers you to a surgeon for trimming, the operation will “free” the tongue only mechanically, but you still have to learn how to use it correctly. An operation at 6 years of age does not guarantee that the child will stop lisp, since pronunciation skills have already been firmly formed. Correcting crooked teeth will also take time.

As for trimming the folds on the lower lip, it is recommended to do it from the age of 4, and on the upper lip - not earlier than reaching the age of 6. In most cases, the tongue frenulum is trimmed in infants under one year of age.

How does pruning happen?

The operation to cut the frenulum of the tongue is called frenotomy. It is performed by a pediatric surgeon or dental surgeon. The child's face is fixed, after which the cutting is carried out with special scissors or a laser. In infancy, the procedure is painless, since the nerve endings in the mucous gum tissue have not yet formed. After the frenulum has been cut, it is recommended to immediately attach the baby to the breast.

Even if the baby cries, know: it’s not because he’s in pain. It’s just that no one likes it when for some reason they hold their face tightly and go into their mouth, and even under the light of a lamp. The procedure itself lasts a matter of seconds - nothing compared to the relief that the baby then experiences.

There are two more methods of surgical treatment:

• frenectomy - when the frenulum is excised almost completely;
• frenuloplasty is an operation that changes the location of the fold in the oral cavity.

No special postoperative care is required. The blood vessels are still located deep, so a few drops of blood are all the consequences. However, over the next week, scar formation occurs, and the tongue must move to avoid re-fusion. The doctor will show you special exercises to promote it.

If the child breaks the frenulum

Little fidgets are often in search of adventures, sometimes unsafe ones. What should you do if your baby falls and cuts the frenulum in his mouth? Of course, you should immediately contact medical care, especially in cases where there is constant bleeding, it is painful for the child to talk or eat, and the soft tissues in the oral cavity are swollen.

The doctor will decide whether the tear needs to be stitched and tell you how to care for the wound. Do not try to treat the baby yourself. If the fusion is improper, rough scars are formed, which negatively affects the formation of bite and articulation.

Let's summarize. Too short a frenulum of the tongue directly affects the child’s quality of life. Whether to trim it or not is up to you, dear parents. Just do not reject the opinions of doctors on this matter. After all, sometimes you need to make small sacrifices in order to save your baby from physical and emotional problems associated with speech impediments in the future.

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…As a result, the baby’s body does not receive enough weight during pregnancy useful substances. Including calcium - the main building material for teeth. On average, 80 percent of young children in Russia suffer from rickets. What can we say about children's teeth? — What should you pay attention to immediately after the birth of a child? - On the frenulum of the tongue. During Soviet medicine, orthodontists went to appointments on infant day and checked children congenital anomalies: cleft palate, shortened frenulum of the tongue, lips. A shortened frenulum of the tongue is quite common. The tongue becomes inactive. The operation is very simple: the frenulum must be trimmed, and certainly within the first two months of life. Now, unfortunately, there is no such practice. — How is the frenulum of the tongue related to dental health? — It is connected with the health of the whole organism in...

The frenulum on the upper lip broke! what to do?. Pediatric medicine

Yesterday Ilya stayed with his dad, they played very well and were furious. Ilya fell and broke his lip, and then I noticed that the frenulum on his upper lip was torn. What to do about it? Which doctor should I go to? And what will the doctor do there?

Physiological phimosis in boys and other abnormalities of the penis

2vtta about the bridle. Other children

The topic has already crawled away and can I write to you here. We are not people with cerebral palsy, but literally at the end of summer we cut the frenulum under the tongue for the second time, so the memory is still fresh. in simple cases, you can use regular pediatric dentistry for free, you can also contact paid dental centers (not all have such a service - this needs to be clarified), both for children and adults (however, the amount can be announced very differently, it does not depend on the professionalism of the surgeon , and from requests from the center, sometimes...

Short bridle. Pediatric medicine

The first time we noticed the frenulum was at 3 months. They told me to wait. Now she is 7 months old, but the frenulum is still short. Do I need to cut it? What kind of doctor does this? Thanks in advance.

conf.7ya.ru

What is a frenulum of the tongue

The frenulum of the tongue looks like a very thin membrane, consisting mainly of connective tissue, the function of which is to attach the tongue to the bottom of the oral cavity.

In other words, a short frenulum of the tongue in a child is some kind of defect in the oral cavity that interferes with the joint movement of the tongue.

In some cases, the frenulum does not look thin at all, which significantly aggravates the situation. Almost half of all parents face this problem. And although a short frenulum can be noticed by a specialist even in newborns, parents learn about it when the baby begins to talk.

The concepts of complete and partial short frenulum of the tongue in a child are also distinguished. The level of discomfort of the child and the type of treatment chosen (surgical intervention or corrective exercises) depend on the type of pathology.

With a full frenulum, the child's tongue is practically immobilized, which makes it much more difficult to pronounce most speech sounds. With this type of pathology, muscle cords form. In the case of partial pathology of the frenulum of the tongue, the role of muscle cords is performed by connective tissue.

Why is a short frenulum dangerous?

A short frenulum is a congenital pathology in which the development and functionality of the ligamentous connection between the tongue and the lower jaw is disrupted. At the same time, the mobility of the tongue in the oral cavity is limited so much that it causes speech problems in the child.

Problems with the frenulum of the tongue in a child can occur in two ways. In young children who are breastfeeding or artificial feeding and have such a pathology, problems with sucking may occur. This occurs due to the fact that the frenulum of the tongue is so short that it simply does not allow the tongue to function adequately.

With a short frenulum of the tongue, the baby cannot be fully breastfed, due to the fact that it is difficult for him to suck out a sufficient amount of breast milk. Therefore, in this case, immediately after the birth of the baby, he has real difficulties with feeding.

The second option for realizing the problem associated with a pathological frenulum of the tongue is speech defects and they arise much later. Partial immobility of the tongue leads to the child being unable to pronounce correctly certain sounds, his speech remains similar to babbling, “lisping.”

Reasons for the development of tongue frenulum pathology in a child

The formation of an anomaly associated with a short hyoid membrane begins before the birth of the child. This is preceded by negative factors, which include:

• genetic predisposition;
• infection of the fetus during pregnancy;
• viral and infectious diseases suffered by the mother during pregnancy;
• mechanical injuries to the expectant mother’s abdomen;
• the age of the expectant mother is over 35 years;
• unfavorable environmental conditions;
• the influence of other factors of unknown etiology.

How to recognize pathology in a child

A neonatologist, pediatrician, or the mother herself can recognize a pathological frenulum of the tongue in a newborn. If during the first and subsequent breastfeeding the child is experiencing difficulties and cannot grasp the nipple correctly, which means there is a reason to consult a doctor.

The second common sign of a pathological frenulum of the tongue in children is the occurrence of a speech defect when they begin to speak in phrases, namely at 3-4 years. Most often, with this anomaly, children do not pronounce several letters: “zh”, “sh”, “sch”, “ch”, “z”, “l” and “r”. Moreover, the sound “l” is easily pronounced if it is followed by a soft vowel, for example, “i”, “yu”, “e”, “e”, “ya”, in other cases it is simply “swallowed”. If there is incorrect pronunciation of sounds, then an examination by a speech therapist is necessary.

The most common symptoms of a tongue tie in a child are the following:

• the child is not able to reach the front teeth of the upper jaw or palate with the tip of his tongue;
• the child may have difficulty moving the tip of the tongue from one side to the other;
• the front teeth of the lower jaw may have a gap between each other;
• when the tongue is pulled forward, its tip remains flat, square or heart-shaped (that is, the front edge of the tongue seems to bifurcate);
• feeding problems in newborns.

In what cases is it necessary to trim the bridle?

The operation of cutting the frenulum of the tongue is called frenulotomy. It is classified as simple and requires only local anesthesia.

Heavy bleeding during frenulotomy is very rare; after a couple of hours the child will be able to return to the usual rhythm of life.

If a short frenulum interferes with the newborn baby's ability to receive nutrition, it must be trimmed. The decision about surgery is made by a pediatric neonatologist.

For infants, as a rule, the operation is performed without anesthesia, since only the sublingual film of connective tissue is dissected, which has practically no blood vessels or nerve endings.

For children aged 3-5 years, surgery to cut the frenulum is performed under local anesthesia. The dentist decides whether surgery is necessary, and the speech therapist prescribes the referral.

Before the operation, the child needs to donate blood for a detailed analysis, which will display numerous indicators, including the number of platelets and the rate of blood clotting.

There are a number of indications for frenulotomy, and limited tongue mobility is not the only one. The formation of malocclusion in a child, displacement and disturbances in the formation of the dentition, low effectiveness of speech therapy and articulation gymnastics, as well as the need to install dental implants or orthodontic structures for the child.

Pathology of the tongue frenulum does not always require surgical intervention. If the child does not experience any discomfort during breastfeeding, and his pronunciation of sounds is satisfactory, then it is likely that a speech therapist will help solve the problem. In this case, the child attends special classes, performs speech therapy exercises, articulation gymnastics, etc.

Treatment methods

Problems associated with a short frenulum of the tongue can be solved with medicinal and non-medicinal methods.

Medication methods involve surgical intervention of varying degrees.

If the sublingual membrane requires dissection, but it is quite thin and elastic, then the doctor dissects it right at the appointment. In this case, anesthesia is not provided, since the procedure is classified as mild.

More complex types of dissection of the frenulum of the tongue include frenulotomy, which is indicated for children with thicker frenulums. Frenulotomy is performed under local anesthesia with tissue dissection and subsequent suturing.

Complications of this operation may include stomatitis, prolonged bleeding from the wound, infection in the wound, etc. After frenulotomy, the child should receive pureed food for some time, as chewing may be painful.

Non-drug methods treatments include special types of massage, exercises to correct the frenulum of the tongue, individual lessons with a speech therapist.

Non-drug methods are recommended when the condition of the child’s tongue frenulum is not critical and allows refusal of surgery. The decision on this is made by a speech therapist, pediatrician and dentist. Classes with a speech therapist include various exercises, articulation gymnastics, tongue twisters and poems.

A massage aimed at stretching the frenulum of the tongue includes a list of special exercises. It is important that the classes are systematic so that they give a positive result.

Massage instead of cutting the frenulum is recommended for children in two cases: if the condition of the frenulum is not so critical and the problem can be solved with non-drug treatment methods; if the frenulum is cut when the child is older (over 5 years old) and the surgery will not solve problems with speech impediment.

Exercises for correcting the frenulum of the tongue and in the postoperative period

Postoperative frenulum stretching and correction exercises are aimed at developing new muscle movements of the tip of the tongue inside and outside the mouth. Regular practice will increase the range of movement of the tongue.

The most common and universal exercises for stretching and correcting the frenulum of the tongue are given here in the article. Following them, you can study at home with your child on your own:

1. Stretch your tongue forward, then stretch the tip up to your nose, then down to your chin. Relax, repeat the exercise several times (at first, up to five repetitions are enough, gradually the number of repetitions must be increased, bringing them to twenty).
2. The exercise is performed by analogy with the previous one, moving the tongue left and right. The number of repetitions is also gradually increased to twenty.
3. Open your mouth wide. Use the tip of your tongue to touch the upper incisors and try to press on the teeth with all your might, not allowing your mouth to close. During each execution, mentally count to ten. The number of repetitions is the same as the previous ones.
4. The exercise is performed in front of a mirror. The mouth is wide open. When performing the exercise, it is important to monitor the movements of the tongue. Pronounce the syllables “dar-dar-dar”, “nar-nar-nar”, “tar-tar-tar”, etc.
5. Sticking your tongue forward as much as possible, alternately “lick” your upper and lower lips.
6. Closing your mouth, move your tongue from right to left and back, forcefully pressing the inside of your cheeks with the tip of your tongue.

To achieve good results, exercises should be performed daily, in several approaches, 15-20 minutes each. The articulation of specific sounds can be gradually corrected.

Speech therapy classes should include exercises to improve the functioning of the speech apparatus and oral kinesthesia, without which it is difficult to claim significant improvements in the development of a child’s speech. Many young patients, after cutting the frenulum, begin to speak more quietly and more quickly, trying to “drown out” speech problems.

If a child has a short frenulum of the tongue, then experts may recommend surgery to eliminate this pathology. We have collected material about at what age this operation is performed, how to trim the frenulum of the tongue in different ways(laser, scalpel). Also from the article you will learn answers to pressing questions about caring for a child after surgery.

At what age is tongue frenulum trimmed for children?

Table No. 1. Features of the operation to trim the frenulum of the tongue in children under 1 year old and older children

Age	Which specialist decides whether the operation is advisable?	Which doctor performs the operation?	Features and consequences of cutting the frenulum in children of different ages
Up to 1 year.	Can give recommendations on frenulum trimming pediatrician, if the child has difficulty sucking the mother's breast.	Dentist.	In newborns, the membrane is very small, it does not yet have nerve fibers and blood vessels, so trimming is performed without local anesthesia, in this case bleeding will be minimal.
From 4 years.	If the child has not undergone surgery before one year, he has grown up and has problems with speech and or are not advisable in this case, then recommendations for trimming the frenulum of the tongue are given by speech therapist.	Dentist.	Trimming the hypoglossal ligament in children over 4 years of age is a painless operation. But at this age children undergo surgery using local anesthesia and suturing.

At what age is it better to have surgery to trim the frenulum of the tongue in children?

The optimal age at which a child needs to have the frenulum trimmed is selected individually. In most cases, the operation is performed before 1 year or immediately after the birth of the child directly in the maternity hospital. The earlier the frenulum trimming operation is performed, the easier it will be.

Dentist D.P. Yumashev on the optimal age for surgery to trim the hypoglossal ligament in children over 1 year of age:

Indications for surgical intervention on the frenulum of the tongue are determined only by a speech therapist; he must give a written opinion. This is usually done at the age of 4-5 years. At an earlier age (for example, at 2 years), the child is unlikely to be able to study with a speech therapist, and without these classes there is no point in performing plastic surgery of the frenulum of the tongue.

Preparing for surgery to trim the frenulum of a child’s tongue: tests, examinations

Before performing the frenulum trimming procedure, no special preparatory measures are required. In some cases, the patient is asked to:

• pass general analysis blood;
• take a blood test for hemosyndrome (blood clotting);
• undergo fluorography.

But most often there is no need for this, since cutting the frenulum is considered a low-traumatic event.

The only advice that doctors give is to feed the child before the operation, since this procedure is stressful for the baby, and hunger causes additional discomfort.

What is the best way to trim the frenulum of the tongue - with a laser or a scalpel?

There are two ways to trim the frenulum: using a scalpel or a laser.

Table No. 2. Features of the operation to trim the frenulum of the tongue with a scalpel and using a laser

How do children cut the frenulum under the tongue with a scalpel?

How to trim the frenulum of the tongue with a laser?

Trimming with a scalpel takes place from 20 to 30 minutes. During the operation, a small incision is made, followed by stitches. The postoperative period may be accompanied by slight swelling and discomfort. As a result of the operation, a small scar appears, which heals within 7-10 days, and later disappears altogether. Until the scar heals, you should rinse your mouth with a special solution and refrain from eating solid food.

Laser cutting of the frenulum takes approximately 10-12 minutes. The process is practically painless and occurs almost without bleeding. The incision is made using a special dental laser, which cuts and instantly seals the wound. Thanks to this, there is virtually no bleeding and there is no need for stitches. The local anesthesia that is used is a dental spray or gel. Within an hour after the operation, the child can return to the normal rhythm of life, and the scar heals within 1-2 days.

Each of these methods is effective and has its supporters and opponents, but the choice always remains with the parents. The price of the methods differs, but this difference is insignificant. You should always remember that saving on your child’s health is not worth it, so choosing a method based solely on cost is unreasonable.

After trimming a child’s tongue frenulum: proper care and possible problems

In rare cases, the following complications may occur after trimming the frenulum of the tongue:

• Unpleasant consequences of the operation may be slight pain that occur after the anesthesia wears off.
• Sometimes in a child the temperature may rise . The reason may be the individual reaction of the body to the operation.
• After cutting the hyoid frenulum in adult children a scar may appear. IN In this case, it is necessary to perform the plastic surgery again.

Other complications may arise if the doctor’s recommendations are not followed. post-operative care. The rehabilitation period after surgery lasts from 2 to 7 days. After this, you can return to the normal rhythm of life.

• carefully monitor oral hygiene;
• give up solid food;
• talk less, as the stitches may come apart.

After complete healing of the scar, speech therapists recommend that adult children do exercises for the muscles of the tongue and stretching the frenulum.

Dentist I.V. Solovyova gives the following recommendations for caring for an adult child after cutting the hyoid ligament:

1. In the first 2 hours after surgery, you are not allowed to eat.
2. In the next 3-4 days, it is recommended to exclude foods that irritate the gastric mucosa (sour, spicy, salty, hard) from the diet and maintain speech rest.
3. For 7 days, treat the oral cavity with antiseptic solutions after meals. Keratoplasty (Solcoseryl, sea buckthorn oil, etc.) is placed in the wound area.
4. In the future, special physical training is prescribed to restore tongue mobility.

Parents often have many questions about caring for their child after tongue tie trimming. The answers to the most popular ones are presented below.

How should a child feel after surgery? What's normal and what's not?

After cutting at a later age, when the operation was performed under local anesthesia, the child may experience slight pain and a rise in temperature. In this case, the doctor will prescribe painkillers to relieve unpleasant symptoms. In the first days, the baby will experience minor inconvenience due to stitches and refuse to eat. The reason for this behavior may be ordinary stress.

The child does not eat. What to feed and drink?

There are cases when the baby feels discomfort after surgery or is simply scared and may refuse to eat. In this case, you should try to feed him with a syringe (without a needle) or some other way so that he does not have to suck or eat from a spoon. Feed should be liquid food that does not require chewing. Immediately after surgery, it is recommended to give the baby breast milk, it acts as an antiseptic. It is necessary to carefully monitor the child’s oral hygiene. After eating, adult children should brush their teeth and rinse their mouths with furatsilin or a decoction of herbs with anti-inflammatory properties, for example, chamomile, sage herb, oak bark.

The child began to smack his lips. What to do?

In the first few days, the baby may smack his lips, in which case it is necessary to pay attention to the correct sucking of the breast or pacifier. If, a few days after the operation, the smacking has not gone away, you should consult a doctor; perhaps the cutting was performed incorrectly.

How long will it take to speak?

It is not recommended to talk much in the first few days. And on the first day after the operation you cannot speak. If stitches were placed, they may take longer to heal or simply prevent the child from communicating. Complete healing of the sutures occurs from 2 to 10 days after surgery, depending on the cutting method. During this period, you should put less strain on the tongue muscles.

What to do if the temperature rises?

If the temperature rises in the first hours after surgery, it is necessary to give the baby a mild antipyretic. You shouldn’t panic because of this right away; each body can react to surgery differently. If, a few days after the operation, the temperature does not go away, you need to consult a doctor; perhaps the doctor performed the cutting with non-sterile instruments, and an infection was introduced.

A white coating and pus appeared under the tongue. What is it and what should I do?

Within a few days after the operation, a white coating may appear; in no case should you think that this is pus; thus, new mucous membrane begins to form. Regular rinsing allows you to remove plaque over several days. Pus can occur if the doctor’s recommendations regarding oral hygiene are not followed. In this case, you need to consult a doctor.

What to do if your tongue is numb or swollen?

Numbness and swelling of the tongue is a normal reaction of the body. The discomfort should go away within 24 hours.

The child is capricious after the operation. What to do?

If the baby begins to be capricious and cry, in this case it is necessary to occupy the child with something, distract him and measure the temperature. This is normal, the baby could be scared, especially if the cutting was done at an older age. Any operation is stressful, and for children it is even more scary and unconscious.

What to do if the seams come apart?

Sometimes there are cases when a child falls and his stitches come apart, then you should immediately consult a doctor for re-suturing, otherwise the scar may become overgrown.

Children's dentist D.P. Yumashev:

Plastic surgery of the frenulum of the tongue is usually performed under local anesthesia, the usual “freezing” and lasts no more than 20 minutes. However, young children do not always allow this particular stage of the operation to be performed. Additional pain relief (eg Nurofen) is usually required in the first 4-6 hours after the procedure. In the future, we recommend a regimen of restriction on the intake of hard food for 4-5 days and active classes with a speech therapist on the 7th day.

Dental surgeon I.V. Solovyova about contraindications to performing surgery to trim the frenulum of the tongue:

Contraindications for surgery:

1. Oncological diseases.
2. Hematological diseases.
3. Acute infectious diseases.
4. Inflammatory diseases of the oral mucosa.
5. Presence of unsanitized lesions in the oral cavity.

Dentist S. I. Zaretsky:

Trimming the frenulum is a very simple operation. I would say that it’s too loud to call it an operation. The mucous membrane is slightly trimmed - a zigzag incision is made, not deep. The mucous membrane heals very quickly, no care is needed. Possible rinses with chamomile or sage. This can be compared to a slight cut on your finger. But the mucous membrane heals much faster than a cut finger. Literally in 2-3 days. This is provided that the child is physically healthy, has normal immunity, and has no systemic diseases such as diabetes mellitus, bronchial asthma, tuberculosis and so on.

If the doctor has identified it through examination, then you should not put off solving the problem indefinitely. The longer you delay solving this problem, the more serious the consequences may be and the harder it will be to eliminate them. Malocclusion, slow development, low weight and other consequences of a short frenulum can cause irreparable consequences for your child's development.

A short frenulum is a common diagnosis in infants, which mothers can hear even in the maternity hospital. There, this pathology must be immediately eliminated, because the newborn baby will have difficulty sucking the mother’s breast or feeding from a bottle. The frenulum can be successfully corrected; the procedure is quick, almost painless and well tolerated, so don’t worry if this happens to your baby. This is a common operation in the practice of pediatric surgeons. Much more dangerous are the consequences that this anomaly can cause in advanced cases.

An abnormally short frenulum occurs in many newborns, but if surgical intervention is performed in time, the child will not remember this problem in the future

Why does a child have a bridle cut, and is it really necessary?

The frenulum of the tongue is a membranous bridge that connects the tongue and the lower jaw (see also:). Thanks to its presence, the tongue is held in its normal position. It is responsible for many important functions in the human body:

• feeding, in infancy - breast sucking;
• correct pronunciation;
• normal bite;
• work of facial muscles.

When the frenulum has developmental pathologies, the normal functioning of the oral cavity is disrupted. Normally, it is located in the middle of the tongue and has a length of about 2.5-3 cm; in babies under one year old it is 8 mm. Typically, abnormalities of the frenulum consist of shortening the length or attaching it to the tip of the tongue. This deviation is called ankyloglossia, or short frenulum. The location of the frenulum in the mouth, characteristic of this anomaly, is shown in the photo.

How is ankyloglossia dangerous for a baby? It causes abnormalities in jaw development and malocclusion. You can understand that a baby has a short frenulum immediately after birth. The baby sucks poorly, gets tired quickly, cries and often latches on to the mother’s breast. During feeding, characteristic clicking sounds are heard, and milk pours out of the mouth. Such children grow slowly and gain weight, because their tongue is inactive, and sucking causes discomfort; it hurts to move the tongue. The same thing is observed in artificial babies.

At an older age, a simple test is used to determine ankyloglossia: if the child can reach the upper palate with the tip of the tongue, the length of the frenulum is normal. A specialist may suspect a deviation when a child has malocclusion, periodontitis, speech therapy pathologies, discomfort when chewing and swallowing food. Usually this problem diagnosed by a speech therapist, who is consulted for help with incorrect pronunciation of sounds and words.

Ankyloglossia must be treated, otherwise it leads to serious disorders:

• chewing food;
• bite;
• pronunciation;
• nasality;
• snoring (apnea);
• inflammatory diseases of the oral cavity;
• frequent colds due to mouth breathing;
• disorders of the gastrointestinal tract;
• scoliosis.

Ankyloglossia often occurs for hereditary reasons. If relatives had such a pathology, the likelihood of having a child with the same disorder is quite high. In addition to genetic predisposition, a short frenulum is formed due to pathologies of the mother’s pregnancy and other factors:

• viral diseases (the first and third trimesters are especially dangerous);
• toxicosis;
• exacerbation of chronic diseases;
• psychotraumatic situations;
• taking alcohol, drugs, chemical poisoning in the first 3 months of pregnancy;
• bad ecological situation in the region of residence;
• abdominal bruise or other injuries.

At what age is this surgery performed?

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There are no age restrictions for plastic surgery; it is performed on both the youngest patients and children school age, and adults. The mother is practically never separated from the child, because the frenuloplasty itself takes place quickly.

Plastic surgery of the lingual frenulum is easier to tolerate in the first months of life. It is best done for a newborn so that the baby can eat comfortably and grow well.

In older children, the correction is more difficult, since it is performed under general anesthesia, and convincing a one-year-old child to sit quietly for a few minutes is much more difficult than operating on an infant. That is why doctors recommend in some cases to delay intervention until the age of 4-5 years.

However, during this time, persistent speech disorders may appear, which will subsequently require long-term correctional work and constant exercises. Other experts recommend trimming the membrane between the tongue and jaw while the upper teeth are growing.

Where is frenuloplasty performed and which doctor should I contact?

If ankyloglossia is suspected, the child will be referred for consultation to a dentist, orthodontist or maxillofacial surgeon, who will confirm or refute the preliminary diagnosis. The decision about the need for surgical intervention will be made jointly by the orthopedist, surgeon and speech therapist.

3 degrees of pathology: mild, moderate and severe

There must be good reasons for this:

• serious nutritional problems in a newborn baby;
• speech therapy disorders that cannot be corrected by conventional means;
• malocclusion;
• violation of proper food intake;
• displacement of teeth, incisor inclination.

Experts divide the degree of pathology on a 5-point scale. Minor deviations can be successfully eliminated without surgery after the age of 1 year by performing special exercises.

The operation is performed in a maternity hospital or in dental clinics for older children. If the case is complex, they operate in the maxillofacial departments.

Surgical correction of a short frenulum

A newborn baby can undergo surgery in the maternity hospital, because at birth the neonatologist will check him for the presence of this pathology. In older children, the procedure is carried out quickly, it does not require a hospital stay, and after it you can immediately go home.

Contraindications to cutting the frenulum may be:

• oncological diseases (including oral cavity);
• blood diseases;
• acute infectious diseases;
• diseases of the oral cavity and teeth (caries, pulpitis, osteomyelitis).

Trimming of the frenulum is carried out if the child is completely healthy; If there is caries or other disease, surgery is not possible

Main types of operations for ankyloglossia

The decision about what type of surgical intervention will be appropriate is made by a specialist. Usually this is:

• frenulotomy - cutting the frenulum and suturing the edges of the mucosa;
• frenulectomy, or the Glickman method, when the frenulum is cut from the side of the teeth;
• frenuloplasty, or Vinogradova’s method, in which a layer of tissue is cut from the mucosa and sutured to the frenulum.

There are other ways - it all depends on the specific case. The specialist will advise how best to proceed in this situation; perhaps, cutting the frenulum will not be necessary.

How is the frenulum trimming procedure performed?

A child over 2 years old needs to be explained why the bridge between the tongue and jaw needs to be cut. It is necessary to calm him down so as not to cause severe stress.

The operation is performed under local anesthesia. A newborn baby does not yet have nerve endings or blood vessels in the frenulum. That is why pruning it does not cause much concern for the baby and parents. The operation time usually takes 5-10 minutes.

For an older child, a lidocaine spray or gel is applied to the site of the future incision. The doctor then trims with a surgical scalpel or scissors. Sutures are not always required.

Treatment with laser

Laser correction is considered the most in a safe way operations and refers to microsurgery. It causes virtually no complications. Sutures are not applied after laser surgery, this is not necessary, and the postoperative period lasts 2 days.

The duration of the laser operation is only 3-5 minutes. This method is suitable for children because it does not cause bleeding or complications in the form of secondary infections, it is accurate and practically painless.

Rehabilitation period

For babies under 9 months, the rehabilitation time is only a few hours, after which the baby can be put to the breast. In older children, the recovery period lasts about a day. After laser surgery, recovery is even faster.

Immediately after the operation, babies begin to eat normally without experiencing discomfort, and breast milk will help the wound in the mouth heal faster. Breasts quickly gain weight and grow well. Speech therapy disorders Infants under one year of age are not diagnosed, and older children will require corrective work with a speech therapist. What exercises are recommended to be carried out in the presence of pathology can be seen in the video.

If pathology is present, it is recommended to regularly perform simple exercises

After frenuloplasty you should:

• do not eat for 2 hours;
• Do not eat irritating foods for 3-4 days - salty, spicy, sour and too hard;
• refuse hot food and drink;
• For some time it is better to eat food pureed;
• do not load your tongue with conversation;
• after eating, you must rinse your mouth with antiseptic agents (chamomile decoction, calendula tincture, Furacilin solution);
• do special exercises developed by your doctor;
• apply sea buckthorn oil and Solcoseryl to the surgical site;
• visit a speech therapist as prescribed by the attending physician;
• if there is pain, the child is given an anesthetic (Nurofen, Ibuprofen).

Are there complications after surgery?

Usually no consequences other than short-term recovery normal function mouth and tongue does not occur. Everything goes quickly, almost painlessly and is well tolerated by the child.

In V. Dahl’s dictionary we read: “A bridle is a leash, a link, a hitch, a bridle or a bundle. The hyoid frenulum is a fused membrane...” Our tongue, like a horse, needs a device that helps it move in the right direction at one speed or another. Then speech flows smoothly and clearly. Each of the three frenulum in a child in the oral cavity is responsible for both the purity of sounds and the beauty of the face.

Before you begin searching for all three frenulums in your baby's mouth, get them in order. own hands: Trim your nails, thoroughly wash and wipe each finger with alcohol. In addition, the examination must be carried out correctly so as not to scare the baby! Start your “search” with these words: “I wonder what’s hiding in that pretty little mouth?” Gently pull and lift the baby's upper lip towards the nose. Your eyes will appear frenulum of the upper lip.

It is shaped like a triangle. Its two sides (“legs”) are attached. One - to the inner surface of the lip from the side of the oral cavity. The second is to the gum above the incisors. The charm of a smile largely depends on how this last one connects to the gum. Normally, the lower edge of the connection should be several millimeters above the base of the gingival papilla. If the fastening is located low, almost at the junction of the incisors, problems arise. They are aggravated if the frenulum itself is dense and massive. In this case, its ridge is intertwined and grows into the gingival papilla located between the upper incisors.

This feature significantly limits the mobility of the upper lip. It looks upturned and exposes the top. Often the mouth is slightly open: the lips cannot close. The child’s face takes on a “squirrel” expression. Moreover, short and tight frenulum in a child's upper lip prevents the growing upper incisors from closing. A gap (diastema) appears. As milk teeth erupt, sometimes it not only does not decrease, but, on the contrary, increases and “spreads.” Permanent teeth often take over this defect. In the old days, the grandmother-neighbor said about the young owner of such a “gap” in the teeth: “He will be lying!”, and an adult was called gap-toothed.

Upper lip frenulum in a child

Modern parents are concerned not so much about the possible talkativeness of their own offspring as about the cosmetic defect of the child’s dentition. In a slight panic, they rush to the dentist and ask to cut the frenulum, believing that then the gap will close. I would not like to upset some overly hasty parents, but such an operation is not performed at the stage of milk teeth. You will have to wait until the permanent upper incisors erupt. However, even then, it would first be advisable to take a photograph of the upper jaw (with the rudiments permanent teeth), and only then, together with the orthodontist, decide whether there is any point in surgery.

The persistence of individual parents knows no bounds... And under the pressure of their requests and tears, dentists sometimes decide trim the frenulum of the upper lip in a child and with milk bite. This leads to the fact that the permanent incisors, when born, begin to overlap each other, and after them, all the other teeth in the upper row grow at random. How can one not remember the saying: “Haste is only needed when catching fleas”! In addition, if the operation on the upper frenulum is performed prematurely, the upper jaw arch can form narrow, and this threatens progeny (bite defect, when the lower jaw moves forward, the upper jaw is small or underdeveloped, and when the jaws are closed, the lower teeth overlap the upper ones). Need I say what problems a child may have with such a bite? This is a defective pronunciation of all whistling, hissing sounds and, of course, the sounds [L’], [L], [R’], [R].

Small injury, big problems. Children very often injure the frenulum of the upper lip, resulting in its rupture. In this case, you should immediately contact your dentist. He will treat the wound (and if necessary, apply stitches) and give a prognosis regarding the further formation of teeth. You may also need an x-ray (if the injury is severe, the rudiments of permanent teeth are injured). A doctor’s help is also necessary because with “spontaneous” healing of the wound (without surgical treatment), the edges of the frenulum may grow together asymmetrically with respect to the central incisors, or a rough scar may appear, limiting the mobility of the upper lip. What could this lead to? As you may have already guessed, this leads to defective pronunciation of sounds.

Frenum of the lower lip in a child

Having admired the frenulum of the upper lip, let's move on to the lower lip. Gently pull back the baby's lower lip. Was this easy to do? So everything is fine! Normal if the child has a frenulum the lower lip is a barely noticeable film.

It is located deep in the hollow between the gum and lip (on the inside), approximately at the level of the gingival papilla of the central lower teeth. But this frenulum should not be attached to the gingival papilla itself! If you see something massive and dense, attached on one side almost to the red border of the lips, and on the other to the gingival papilla of the central lower teeth, you should be concerned. Of course, there is nothing dangerous in this! It’s just that such a frenulum “keeps in check” the baby’s lower lip. That is why he speaks reluctantly, and the sounds are not quite correct...

Tongue frenulum in a child

Everyone knows the third frenulum - the sublingual frenulum, but it is not so easy to see it in the baby’s mouth. Don't even try to grab your tongue and lift it! The child is unlikely to tolerate this. In addition, you can seriously injure the mucous membrane of the tongue. The baby himself must demonstrate the hyoid frenulum, and voluntarily. And you use little tricks.

Open your mouth wide and pull the tip of your tongue towards the roof of your mouth. Then say: “My tongue rises high, high! And you?" Take a moment to examine the baby's hyoid frenulum.

• Compete to see who can click their tongue loudest. We open our mouth wide and press our tongue firmly to the roof of our mouth. For a short moment sublingual frenulum in a child will appear to your eyes in all its glory. But it quickly ends, and the tongue leaves the palate with a resounding click.
• Ask your child with a sly look: “Is there a mushroom growing in your mouth? And it’s growing for me!” Show your baby the wonders of articulation by sucking your tongue to the roof of your mouth and holding it there for a while. Then, without wasting time, suggest: “Let’s grow a fungus in your mouth.” Sit together in front of a mirror and “sculpt” a fungus from your tongue. The child will not be able to do this right away. But when the fungus finally “grows”, slowly examine its leg - that very coveted frenulum.

Have you seen a film that absolutely does not interfere with the rise of your tongue? Great! However, various deviations from the norm are also possible.

1. The frenulum is thin, almost transparent, but prevents the tongue from rising.
2. The bridle is thin. Its front edge is attached close to the tip of the tongue (when the tongue rises upward, the tip bifurcates into a “heart”).
3. The bridle resembles a dense short cord. When you try to stick your tongue out of your mouth, its tip curls up and the back of the tongue “bulges out.”
4. A dense short cord of the frenulum is tightly fused with the muscles of the tongue. All movements of the tongue are sharply limited.
5. The tongue seems to have fused with the bottom of the mouth. With such a language it’s not only impossible to speak, it’s impossible to eat...

In that case trimming the frenulum of the tongue in children could be a way out.

Should a child's tongue frenulum be trimmed?

Oh, how parents don’t like to listen to arguments in favor of surgery on the sublingual frenulum in a child! Believe me, speech therapists are dragging their feet until the very end with its dissection. But there are cases when surgery is necessary. In the first, second and third options, only the frenulum will be dissected. In the fourth and fifth cases, the intervention is more complex, sometimes under general anesthesia. I know that parents will talk about mental trauma, stress, etc. I will not argue, but will only list the main consequences of our inaction.

• Formation of malocclusion: progenia, oblique bite, anterior open bite, lateral open bite.
• Incorrect formation of the velopharyngeal ring: the child’s voice will take on a nasal tone.
• Violation of physiological and speech breathing; formation of persistent mouth breathing: endless colds.
• Quiet “fading” voice, inexpressive speech.
• Poor posture: stooping and curvature of the spine.
• Complex dyslalia (numerous disturbances in sound pronunciation or disturbances in sound pronunciation across all phonetic groups). If you do decide to have surgery, be sure to visit a speech therapist, pediatrician, and dental surgeon. The latter gives directions for a clinical blood test with hemosyndrome and a clinical urine test.

After the operation, the child must undergo a rehabilitation course with a speech therapist (classes on stretching the muscles of the tongue and hyoid frenulum). All this equally applies to operations on the frenulum of the upper and lower lips: the same doctor visits, tests and stretching exercises.

The frenulum of the tongue serves to control its mobility, connect to the floor of the mouth, and regulate respiratory, chewing and speech functions. Normally, it is located along the inner surface of the tongue, starting from its middle and ending at the base of the gums of the lower incisors. A short frenulum of the tongue is scientifically called ankyloglossia, which translated from Greek means “curved tongue,” and is a fairly common congenital pathology.

In boys, the anomaly occurs several times more often than in girls, and is often hereditary.

The clinical picture of this pathology is as follows:

• the tip of the tongue is fixed to the bottom of the oral cavity and is not able to move beyond it;
• when trying to stick out the tongue, its arched deformation occurs;
• when you try to raise the tip of the tongue, the frenulum tightens and gives it a heart-shaped, forked shape;
• The tongue constantly folds into a groove with a peculiar clicking sound.

Short frenulum of the tongue in newborns

The tongue plays one of the most important roles during the feeding process of babies. It helps draw the nipple into the correct position in the mouth, creating a groove along its length to hold the nipple in place and collect milk before swallowing. With a short frenulum of the tongue, the following breastfeeding problems arise:

• The baby cannot attach to the breast correctly and hold the nipple in the mouth for a long time;
• It is difficult for him to absorb milk, he squeezes and bites the nipples with his gums, causing them to be sore and cracked. also does not lead to improvement;
• During feeding, the baby swallows air, which causes colic and frequent regurgitation;
• Ineffective breastfeeding leads to insufficient weight gain in the baby and an increase in the duration of feeding.

The main indication for trimming the frenulum of the tongue in newborns is insufficient weight gain. More recently, this operation, also called frenulotomy, was often performed in the maternity hospital.

Now most doctors believe that the frenulum can stretch with age on its own or after regularly performing special articulation exercises. Therefore, trimming it in newborns has become much less common. However, if the short frenulum significantly interferes breastfeeding, the baby cannot get the required amount of milk, is nervous and is not gaining weight well, then it needs to be trimmed. The operation can be performed in the maternity hospital or a little later in the children's dental office.

Up to 9 months, the frenulum is a thin cord without muscles and blood vessels. It is cut using special scissors, without stitches or anesthesia. The operation lasts several minutes, after which the baby is immediately put to the breast. With age, the frenulum becomes denser, blood vessels appear in it, therefore, after 9 months, frenulotomy is performed under local anesthesia and with mandatory suturing.

Consequences of a short frenulum of the tongue

If the short frenulum of the tongue was not trimmed in the maternity hospital, then later it can cause the following functional disorders, medical, dental and speech therapy problems:

• delayed development of the lower jaw;
• or ;
• turning the lower incisors inwards;
• bifurcation, heart-shaped tip of the tongue;
• permanent injury to the frenulum by the lower incisors;
• the occurrence of cervical caries of the lower teeth;
• incorrect pronunciation of sounds that require an upper elevation of the tongue: L, R, Ch, Shch, D, T, Sh, Zh;
• pain in the stomach, bloating, gas formation due to poor chewing of food and swallowing air while eating;
• snoring and sleep apnea.

By the age of 18 months, the free tip of a child’s tongue should normally be at least 16 mm. If a child cannot lick his lips with his tongue, raise the tip of his tongue to the palate and run it along the gums, then his frenulum is of insufficient length and elasticity. Most often in preschool age a short frenulum of the tongue is diagnosed by a speech therapist or dentist due to problems with speech, bite, and teeth.

If the shortening is slight, you can try to stretch the frenulum using special speech therapy exercises: “Horses”, “Accordions”, “Painter”, “Clock”, “Swing”, “ Delicious jam"and speech therapy massage. If attempts do not produce visible results or the frenulum is too short, then surgical intervention must be resorted to.

In some cases, surgery can be done earlier, but only for medical reasons and a doctor’s direction.

Depending on the situation, the surgeon may use the method of dissection, excision, or relocation of the attachment site. However, the operation itself does not lead to automatic normalization of speech, but only frees the tip of the tongue from tension. Therefore, a week after the operation, the child must undergo a course of classes with a speech therapist to train and strengthen the muscles involved in raising the tongue, producing impaired sounds and consolidating their correct pronunciation.

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