Causes of short frenulum of the tongue. How to understand that a child has a short frenulum. Feeding difficulties during the newborn period

The frenulum is a small sublingual piece of tissue that is located in the oral cavity. It comes in different lengths and elasticity, and may also differ in the location of attachment. These parameters directly affect the clarity of speech, the correct pronunciation of most sounds and the ability to eat food in a normal way. It is the frenulum of the tongue that is often the culprit of problems with teeth and all kinds of speech defects.

How to check the hyoid frenulum?

The hyoid frenulum can have different lengths and be attached in different places. The norm is a situation in which its location and size do not limit the movement of the tongue. In an adult, the jumper usually varies from 2.5 to 3 cm; in babies under one year old, it should be about 8 mm.

You can visually check what the sublingual cord looks like and whether there are any abnormalities, even in a newborn child. To do this, just pull back the lower lip so that the baby opens his mouth. This will allow you to assess where the septum is attached in relation to the lower row of future teeth, and how it holds the tongue. For comparison, it is enough to find photos and videos of a normal frenulum without congenital anomalies.

When is pruning necessary?

The presence of an abnormal septum does not always require surgical intervention. Indications for surgical correction of the frenulum are situations when:

difficulties arise with feeding the baby;
an incorrect bite is formed;
displacement of teeth.

In case of disorders in the development of speech associated with pathology, the problem in most cases is solved non-surgically. Stretching the cord is carried out using gymnastic exercises and massage.

Causes of a short frenulum under the tongue

The pathology of a short connecting bridge under the tongue in children implies not only an inappropriate length, but also an incorrect location in the oral cavity. An abnormal frenulum is formed even before the baby is born.

Factors that cause a jumper defect to appear include:

Heredity. The presence of such an anomaly in parents increases the chances of its development in the child.
Surrounding ecology.
Injuries in the abdominal area during pregnancy.
Age of the pregnant woman. In babies born to women who give birth after 35 years, the likelihood of cord pathology increases.
Availability chronic diseases in a pregnant woman.
Infection of the fetus during pregnancy.
A viral or infectious disease contracted by a woman during pregnancy.

Symptoms of a shortened frenulum with photos

A dentist or an experienced pediatrician can accurately diagnose the pathology of the bridge. However, parents themselves can suspect the presence of a problem if they have certain symptoms, as well as during a visual examination using photos of normally formed cords from the Internet. Infants with a short frenulum typically:

strong smacking and clicking of the tongue when feeding;
biting the nipple during sucking;
using the lips to grasp the breast;
the requirement to frequently apply to the breast;
releasing the nipple from the mouth;
poor weight gain;
capriciousness.

Older children may experience the following symptoms:

stopping breathing during sleep;
aerophagia;
V-shaped tip of the tongue;
frequent tears of the frenulum;
snore;
increased secretion of saliva when talking.

The age of the child at which it is advisable to trim

An urgent question is at what age is it better to dissect the frenulum under the tongue. If a problem is discovered in the maternity hospital, and the identified pathology causes difficulties in feeding the baby, then it is eliminated there. The procedure is painless, and after it is completed, the baby is applied to the chest to stop bleeding.

Starting from 6 months, such an operation becomes dangerous, since babies are not able to remain motionless for a long time, and any sudden movement of the head during manipulation can lead to serious damage.

Pruning should be postponed until 4-5 years. At this age, it is already clear whether the pathology affects speech, and whether correction can be carried out with the help of stretching, massage and special exercises. Of course, an adult can also trim the septum, but this requires anesthesia, suturing, and the recovery process will take longer.

How is the operation performed?

Correction of the frenulum can be carried out in the maternity hospital in a newborn if this defect was discovered immediately after birth. At this age, it is trimmed so that the baby can eat properly.

In cases where shortening of the frenulum is diagnosed in older children, and various speech therapy exercises and massage cannot correct the defect, surgical intervention is required. There are three main types of hyoid frenulum trimming:

frenulotomy;
frenulectomy;
frenuloplasty.

Frenectomy - dissection of a skin fold

The second name for frenectomy is the Glickman method. The essence of the method comes down to the use of clamps with which the frenulum is fixed. After this, cuts are made between the lip and the clamp. Sutures are placed on the edges of the wound. In newborns, dissection of the skin fold is carried out quite easily and not painfully, without the use of anesthesia, since they do not yet have blood vessels and nerve endings in this area.

After 2-3 years of age in children, the structure of the lingual fold changes. Vessels appear in the connective tissue, and the septum itself becomes denser and fleshier. As a result, the operation will require anesthesia and subsequent suturing of the wound.

Frenulotomy

Frenulotomy is the most in a simple way carry out trimming, which is aimed at increasing the length of the shortened bridge under the tongue. During such an operation, you need to make an incision on it using special scissors closer to the lower row of front teeth. The distance at which the frenulum of the tongue is trimmed is 1/3 of its total length. The mucous membrane is dissected, and then the cords themselves are dissected. Next, the sides of the mucosa are brought together and sutures are placed every 3-4 mm.

Frenuloplasty

This method of plastic surgery, which is also called the Vinogradova method, is based on changing the location of the frenulum attachment in the oral cavity. This plastic frenulum of the tongue is carried out in several stages:

a flap in the shape of a triangle is cut out and peeled off, and the edges of the wound are connected by suturing;
an incision is made in the direction from the septum to the papilla between the front teeth;
the triangle is sewn to the surface of the wound.

Other similar methods of plastic surgery of a short frenulum are also used, including labial bridges (for more details, see the article: short frenulum in a child: photos, methods of correcting the defect). For example, Limberg or Popovich plastic surgery.

Laser trimming

In addition to using scissors or a scalpel to trim a shortened sublingual septum (which is often quite painful), in modern dentistry doctors use a laser. Laser circumcision is a more gentle method of surgery, which is worth turning to if the patient is a small child.

Laser frenulum removal has a number of advantages:

simultaneous evaporation of tissue areas;
absence of blood during the operation;
wound closure;
coagulation of blood vessels or, in other words, their baking;
sterilization of incision edges;
no seams;
fast healing;
minimal risk of complications;
ease of the procedure.

Contraindications for surgery

Usually, surgery to trim the hyoid frenulum has no contraindications. However, there are certain circumstances related to health problems in which doctors do not recommend the procedure or may advise postponing it for a period of time. These include:

caries;
infectious diseases;
low blood clotting;
oncology in the oral cavity (we recommend reading: first stage of oral oncology: symptoms, prognosis);
pulpitis, stomatitis or other diseases in the mouth.

Is it possible to stretch the hyoid frenulum?

Why rush to trim a short jumper if you should first try to stretch it? For this there is speech therapy massage bridles and special exercises. In addition, gymnastics is also relevant after surgery and when restoring the septum if it is torn.

Necessary:

stretch your tongue forward and move it around;
alternately reach with the tip of the tongue to the lower and upper lips or teeth;
click your tongue, holding it at the roof of your mouth and sharply lowering it down;
with your mouth closed, move the tip of your tongue between your cheeks;
stretch out your lips with a tube with your mouth closed and smack.

In addition, children should be allowed to lick the spoon more often. Another way: drip jam on the lip and ask the baby to lick it. Also let your baby smile more often with his lips closed.

What are the consequences of a short frenulum?

Pathology associated with a shortened frenulum is a fairly common problem. This is a congenital defect, as a result of which there is a disruption in the development and functioning of the element connecting the tongue and the lower jaw, which, in turn, affects the mobility of the speech organ itself. A short frenulum of the tongue in a child leads to the following consequences:

Among children, a pathology of the structure of the oral cavity in the form of a short frenulum of the tongue, called ankyloglossia, is common.

Often, a short frenulum of the tongue is detected in newborns immediately after birth, during examination in the maternity hospital.

The pathology is recognized quite simply: normally, a thin cord connecting the tongue and the lower oral cavity reaches the middle of the tongue, while an abnormal frenulum is attached to its very tip.

It also happens that the frenulum is practically absent and the tongue fuses with the lower part of the mouth.

Prerequisites for the development of the disorder

In half of the cases, ankyloglossia is diagnosed in children whose mother and father (or one of the parents) had similar problems. Pathology in the embryo develops in the mother's womb in the first half of pregnancy due to:

absence or untimely treatment of a viral disease in the expectant mother in the 1st and 2nd trimesters;
treatment of diseases with antibiotics;
working with chemicals (paints, varnishes, solutions);
frequent stressful conditions;
age expectant mother(over 35 years old);
unfavorable ecology.

Types of abnormal frenulum

Five types of short hyoid frenulum have been identified:

transparent thin, hindering the movement of the tongue;
thin, translucent, fixed at the leading edge almost at the tip of the tongue;
thick, opaque, attached near the edge of the tongue;
a short and dense cord connected to the muscles of the tongue (a common anomaly in children suffering from palatal and labial clefts);
a fold fused with the lingual muscles.

Symptoms and signs of pathology

It is easy to identify a short frenulum of the tongue from the first days of a child’s life. The main and first sign of the disease is difficulty in breastfeeding.

To suck milk from the mother's breast, the newborn needs to make serious efforts, using other organs in addition to the tongue. The tongue irritates the mother's nipple, causing breast milk to be released.

With a shortened frenulum, this process is quite complicated and many babies try to compensate for low tongue mobility with their gums and lips, which is quite difficult for both the child and the mother.

On the left is a normal frenulum, on the right is a pathological one

The baby gets tired quickly, the mother feels discomfort when feeding, the breastfeeding process is disrupted, meals become frequent, long and restless with breaks for rest.

While attaching to the mother's breast, the baby becomes capricious, arches, throws back his head, and may even refuse the breast altogether. As a result, the baby is nervous and underweight.

In older children and adults, due to a short frenulum, the bite is disrupted, the sound pronunciation of hissing and other letters becomes difficult, the installation of implants and dentures becomes problematic, and oral diseases develop.

Self-diagnosis of the disease

Frenum defects are more common in boys. Parents can visually diagnose the pathology themselves.

The movements of the child's tongue will be constrained or the tongue will be attached to the lower jaw, the child will not be able to stick it out of the mouth.

Treatment methods

Today, two methods of treating short frenulum in children are in demand: conservative and surgical trimming.

If you refuse surgical intervention to trim the frenulum, you can perform special gymnastics at home, developed by speech therapists, aimed at stretching.

To stretch the frenulum, a speech therapist may recommend speech therapy massage. The procedure is quite unpleasant, but very effective. This is done with absolutely clean hands; sometimes the doctor may allow himself to wrap his fingers in a sterile handkerchief or bandage:

Hold the bridle between your thumb and forefinger and move them along the tie from bottom to top.
Place your middle and index fingers under your tongue so that the frenulum is between them; Use your thumb to press on the front of your tongue and gently pull it out.
Pull the tip of your tongue alternately up and down, then carefully pull the bridge up with your index finger.
Place the edge of the pipette cut into a ring on the tip of your tongue, press the ring to the roof of your mouth with your tongue and close your mouth; repeat the exercise three times a day, 8-10 times.

Prompt solution to the problem

Surgical intervention is indicated for:

broken bite;
displacement of teeth;
Not correct pronunciation sounds and letters that cannot be corrected by classical methods;
for problems with breastfeeding.

The decision about the need for surgery must be made jointly by the speech therapist, surgeon and orthopedist. Many doctors believe that the frenulum can stretch on its own with age.

For newborn babies, the frenulum is cut in the maternity hospital using special scissors. Until the age of 9 months, it does not have time to acquire blood vessels and nerve endings, so the operation is completely painless, bloodless and performed under local anesthesia.

Rehabilitation lasts only a couple of hours, after which the baby is placed on the mother's breast. As a result, children's appetite increases sharply.

For older children, frenulum trimming is necessary before all baby teeth are completely replaced. The age of 5-8 years is considered a favorable period, but in exceptional cases the operation can be performed earlier.

Before pruning, the attending physician will refer the patient to the laboratory for blood and urine tests. The procedure is performed in a clinic under local anesthesia and lasts no more than 10 minutes. To avoid possible blood loss, electric scissors or an electrocoagulator are used.

After a week, the child should undergo a rehabilitation speech therapy course, which consists of training and strengthening the muscles involved in raising the tongue, producing disturbed sounds and consolidating their correct pronunciation.

Trimming the frenulum of the tongue in children is much easier than in adult patients:

Consequences of ankyloglossia

Children with an abnormal frenulum under the tongue are not able to gain the body weight required for their age due to constant malnutrition, and they lag behind their peers in growth. Their sucking process is disrupted, the newborn baby is not able to grasp the mother's nipple, the feeding process becomes long and intermittent.

On the picture short bridle close-up of a child's tongue

At an older age, the child has serious problems:

A short tongue frenulum in a child should not cause panic among parents. Before deciding on an operation to trim the jumper, you need to get advice from specialists.

But it cannot be avoided if acute orthopedic or dental ailments are diagnosed. In other cases, you should rely on the doctor’s experience and advice.

Classic frenulum therapy methods such as special exercises and speech therapy massage will require application enormous forces and patience. Therefore, it is necessary to act, because the health of the child is in the hands of his parents!

Short frenulum of the tongue in a child: how to determine

Short frenulum of the tongue - parents encounter this problem around the time their baby turns 3-4 years old. He has been trying to speak for a long time, knows a lot of words, knows how to construct complex phrases, but does not pronounce some words accurately.

Grandmothers assure that in another year the child will “speak out”; mothers work with their children using special methods for early development, but the problem is not solved. If your child is still babbling at 4 years old, it is time to visit the pediatric dentist.

What is a frenulum of the tongue

The frenulum of the tongue externally resembles a 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.

Pathology of the frenulum of the tongue can be congenital and hereditary. It should be understood that these concepts are completely different. If a congenital pathology is already present at birth, then a hereditary pathology is most often already present in one of the family members.

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 case of partial pathology of the frenulum of the tongue, the role of muscle cords is played 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 to such an extent that it leads to speech problems in the child.

Problems with the frenulum of the tongue in a child can occur in two ways. Young children who are breastfed or bottle-fed and have this pathology may have problems with sucking. 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 sufficient quantity 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 fact that the child is not able to pronounce certain sounds correctly; 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 breastfeedings the baby experiences difficulties and cannot grasp the nipple correctly, then 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.

It is important to understand that if the problem of the tongue frenulum exists, then sooner or later it will have to be solved. The sooner measures are taken, the easier and more painlessly the baby will endure them.

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 the operation is made pediatrician 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.

Surgical intervention is performed provided that the pathology is moderate or severe with limited tongue mobility. After surgery, speech therapy sessions are necessary.

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.

To more complex types dissection of the frenulum of the tongue includes 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 massage, exercises to correct the frenulum of the tongue, individual sessions 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.

Since a short frenulum of the tongue causes some speech defects, classes with a speech therapist are necessary both in the postoperative period and as a correction.

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.

Articulation exercises by themselves will not improve speech and will not be able to correct the defect, so it is very important to carry them out in conjunction with individual speech therapy sessions.

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:

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).
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.
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.
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.
Sticking your tongue forward as much as possible, alternately “lick” your upper and lower lips.
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.

Important! You can begin to perform exercises for the frenulum of the tongue only after the wound has completely healed.

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.

Instead of a conclusion

A short frenulum of the tongue is not a serious problem, but, nevertheless, it cannot be ignored.

If by the age of 5 your child still cannot pronounce some letters, his speech is slurred and not clear, parents have serious cause for concern.

As a rule, after surgery, children need from 6 months to 2 years to fully restore the functioning of the speech apparatus, which means that there is very little time left before school. It is better to start fixing the problem in time than to later be forced to register the child in a speech boarding school.

How to determine if a child has a short frenulum of the tongue and whether it needs to be trimmed

Dear parents, today we will talk about how to identify a short frenulum of the tongue in a baby. In this article you will learn what main signs can be used to suspect such a condition, why this happens, and what treatment methods are available. You will know what age is considered optimal for the surgical procedure, as well as what contraindications exist for such therapy.

Short frenulum - what is it?

Upon visual inspection, this formation resembles a thin membrane represented by connective tissue. The main function is to attach the tongue to the oral cavity (lower part). A child's tongue tie is a condition that makes it difficult for the fleshy organ to move.

It can be congenital and hereditary. Consider partial and full form. When complete, the formation of muscles (cords) is observed, the tongue is actually immobilized, and pronunciation is very poor. Partial - connective tissue is replaced by muscle cords.

There are three degrees of functional limitation of the fleshy organ:

light - size greater than 15 mm, there is a violation in sound pronunciation;
medium - frenulum from 10 to 15 mm, accompanied by impaired pronunciation, inability to reach the palate with the tongue;
heavy - length up to 10 mm, the baby is not able to lick his lips, cannot pronounce sounds correctly, touch the palate with his tongue, or stick out his tongue.

Possible reasons

There are a number of factors that influence the formation of frenulum shortening:

heredity;
bad ecology;
infection of the fetus during gestation;
injury to the pregnant woman's abdomen;
factors of unknown etiology;
infectious processes in the body of the expectant mother;
woman's age over 35 years.

Characteristic signs of the presence of a short frenulum include:

increased salivation;
digestive problems;
difficulty chewing solid food;
a quiet voice with a nasal tone;
frequent caries;
malocclusion;
gum recession;
periodontitis;
dyslalia (organic type);
The incisors on the lower jaw tilt inward.

Signs in infants

The following symptoms may indicate that your little one has a short frenulum:

the baby bites the breast while sucking;
lack of weight gain;
smacking when feeding;
prolonged act of sucking;
frequent feeling of hunger;
capriciousness when feeding.

Home diagnostic method

To determine whether a baby has a short or long frenulum, you need to ask him to perform certain actions.

Let the little one stick out his tongue at you. If the frenulum is short, it will be difficult for the child to remove it completely from the mouth or the edge of the tongue will be tilted down.
Let your baby raise his tongue to the roof of his mouth. If there is a deviation, the child will either not reach at all or the lateral sides of the tongue will rise, the central one will be practically inactive.

In addition, you can visually determine whether the frenulum is normal or not. So, normally, a newborn toddler’s frenulum is longer than 8 mm, and a five-year-old baby’s frenulum is longer than 17 mm.

Where to contact

If you are interested in the question of where to trim a child’s tongue frenulum, then the answer is simple - in a dental clinic. The procedure will be carried out by a surgeon, but before you decide to take this step, you will need to consult with several specialists:

at the pediatrician - for problems with eating;
see a speech therapist if there are difficulties in pronunciation;
at the orthodontist - if malocclusion develops.

Therapy can be either medicinal or non-medicinal. Everything will depend on the severity of the child’s condition.

Non-drug methods include:

massage;
classes with a speech therapist;
correction exercises;
articulation gymnastics.

Drug therapy involves surgery. It can be of varying degrees:

easy - will be carried out directly at the appointment and without anesthesia in cases where the sublingual membrane is plastic and very thin;
frenulotomy - will be performed on a child with a thick frenulum under local anesthesia, stitches will be placed.

You need to know that the operation can be complicated:

Exercises for correction

Ask your child to stick out his tongue and try to touch the tip of his nose, then his chin. Take a break and do another approach. At first, the exercise should be repeated no more than five times, and over time it is increased to 20.
Let the baby stick out his tongue and begin to move it left and right. Initially five approaches, increased to 20.
We ask the little one to open his mouth wide. Let him touch the tip of his tongue to the upper incisors and try to press on the teeth with all his strength. It is important that your mouth remains open. Each time the child must count to ten (to himself). We also start small and work up to 20.
We spend it in front of the mirror. Let the little one open his mouth wide and follow the movements of his tongue when pronouncing the syllables “kar - kar - kar”, “bar - bar - bar”.
Ask your child to lick his lips, first the top, then the bottom.
Let the baby close his mouth and move his tongue in one direction or the other. With all his might he presses on the inside of his cheeks with the tip of his tongue.
To achieve a good and quick effect, you need to do the exercise daily for 15 minutes.
If correction is prescribed after surgery, it begins only after the wound has healed.

Operation

The procedure is performed under local anesthesia.

Indications for surgical intervention will be:

severe limitation in tongue mobility;
moderate severity of the disease in the absence of positive results from therapeutic treatment;
lack of monthly weight gain;
development of malocclusion;
inability to latch onto the nipple during feeding;
the process of formation of displaced dentition;
the need to install dentures, including removable ones.

It is worth considering that the operation may have certain contraindications. These include:

infectious processes in the oral cavity;
oncology;
blood diseases;
gingivitis;
stomatitis;
acute infectious process in the body.

Depending on the age, the child may be prescribed one of three types of surgery:

frenulotomy (can be performed on children up to nine months old) - an incision is made with scissors closer to the teeth, the mucous membrane is initially dissected, then the muscle cords are applied, sutures are applied;
frenulectomy (performed on a child over five years old) - the septum is fixed with a clamp, an incision is made between it and the lip, and stitches are applied;
frenuloplasty (applicable for children over five years old) - a triangular flap is truncated from the bridge, then an incision is made and this flap is sewn in the right place to lengthen the frenulum.

My son had his bridle cut when he was 7 months old. I was not present at the procedure, I was very worried. Dad and grandmother went with him. Everything went without complications, and the child recovered quickly.

Laser treatment

IN last years They are increasingly using the method of cutting the frenulum using a laser. This method has a number of advantages:

practically painless;
there is no need for stitches;
the cut is made accurately;
wounds heal quickly;
minimum consequences or their complete absence;
disinfecting properties prevent infection;
no bleeding during surgery.

Optimal age

If you are wondering at what age a child’s tongue frenulum is cut - if it is detected early in the first month of life, while still in the maternity hospital. The best time The first year of a baby's life is considered. However, there are often cases when parents do not notice the problem, and realize that something has gone wrong when problems with pronunciation arise at the age of five. At this time, a longer operation will be performed under anesthesia.

Now you know how the procedure is carried out. Remember that the lack of timely treatment can lead to problems with speech and the development of pathology. No matter how sorry you feel for the baby, if there is an urgent need, go for surgery.

A child has a short hyoid frenulum: methods of diagnosis and correction

Many parents have encountered short frenulum in their children. As a rule, the doctor in the maternity hospital warns about the presence of an oral cavity defect. But not always a short frenulum of the tongue in a child can be diagnosed in infancy. Is surgery necessary for older children? Or can we get by with traditional treatment methods? It all depends on the possible consequences for the child.

Types of bridles

The frenulum is a small mucous cord in the mouth that can affect the condition of the bite, the quality of breastfeeding, diction and dental health. If the frenulum is short, the baby may have problems with sucking, and subsequently with oral aesthetics and speech.

There are three frenulums in the mouth, although the most famous is the frenulum of the tongue - a ligament that connects it to the floor of the mouth. The abnormal development of this mucous stripe is called ankyloglossia. Malformations of the other two frenulums are less common, but no less significant for the full development of the child.

Upper lip frenulum

Location: enters the upper lip and gum mucosa above the front incisors.

Consequences:

diastema (gap between the front teeth);
tooth sensitivity;
exposure of roots;
tooth neck caries;
malocclusion;
development of periodontitis;
difficulty pronouncing labial sounds, vowels “o”, “u”.

Time for the operation: in the maternity hospital or at 7-8 years (after the appearance of the central incisors).

Frenum of the lower lip

Location: woven into the lower lip and gum mucosa above the level of the front incisors.

dysfunction of sucking;
malocclusion;
caries of the front teeth;
diastema of the lower anterior incisors.

Time for surgery: at any age, but more often after the appearance of molars.

Tongue frenulum

Location: connects the tongue and the lower part of the oral cavity at a distance of 0.5-0.8 mm from the neck of the front teeth.

Consequences:

violations of diction (incorrect pronunciation of hissing letters, “d”, “t”, “r”, “l” and other letters);
problems with breastfeeding;
difficulty chewing solid food in older age;
malocclusion;
development of periodontitis, gingivitis and other diseases of the oral cavity;
salivation;
sleep problems, apnea;
belching, diarrhea, indigestion;
a quiet, inexpressive voice with a nasal tinge;
breathing disorders, formation of mouth breathing, as a result, frequent colds;
curvature of the spine.

Time for operation:

0-9 months;
2-2.5 years (deciduous bite has formed, incorrect pronunciation has not yet been fixed);
after 5 years (permanent bite is formed).

On the left is the correct position of the tongue. On the right is the frenulum of the tongue.

Tongue frenulum

The most common anomaly is a short frenulum of the tongue in a child. According to the World Health Organization, every three out of ten children suffer from this pathology, with boys three times more likely than girls. In 50% of cases, ankyloglossia is inherited, but sometimes it can be a manifestation of a congenital malformation. The formation of intrauterine anomalies can be affected by stress, medication, exposure chemical substances on the mother's body during pregnancy. The risk of developing ankyloglossia is likely in mothers over 35 years of age.

Signs of a short frenulum

The normal length of the tongue frenulum in newborns should be at least 8 mm. By the age of five, this figure can increase to 17 mm. By 18 months, the length of the free tip of the tongue is 16 mm. To diagnose an anomaly at home, you do not need to resort to measurements. This will help to make pronounced symptoms.

In infants:

frequent and long feedings with breaks for rest;
whims during breastfeeding, arching, throwing back the head;
underweight;
biting the breast while sucking;
“clicking” sounds during feeding;
breast refusal.

In older children and adults:

incorrect bite;
periodontitis;
problems with fixation of implants and prostheses;
difficulties in pronouncing hissing sounds, “r”, “l”, “d”, “t” and other letters.

Some changes in the structure of the oral cavity may also indicate a short frenulum:

lower incisors turned inward;
a forked tip of the tongue and a depression on its surface when pulled out;
inability to reach the roof of your mouth with your tongue, lick your lips or stick it outside your mouth;
the tongue appears humped, the back part is raised, and the lower part is pressed to the bottom;
Problems with eating solid food: To swallow, it must be placed on the back of the tongue.

Moderate to severe degrees will cause orthodontic problems in the future. Early correction is important!

Test to determine language functionality

American professor Alison Haselbaker in her book “Tongue-Tie” proposed a test for determining the length of the frenulum, in which she took it into account appearance and functionality. Each parameter is assessed at three levels of development. In general, there are three degrees of anomaly:

light - the length of the jumper is more than 15 mm in case of disturbances in the pronunciation of sounds;
average - length less than 15 mm in the presence of all signs;
heavy - length from 0 to 10 mm in the presence of all signs.

The test evaluates the frenulum according to the following parameters.

Place your finger in the middle of your baby's bottom lip and move it from one side of the mouth to the other. The tongue should follow the finger freely.
Ask your baby to raise his tongue to the upper palate. The tip should reach the top freely.
Run your finger from the middle of the lower lip to the child's chin. The tongue reaches the lower lip freely.
Touch your fingertip to your upper palate. During sucking, the tongue should be completely smoothed and contracted from the tip to the roof of the mouth.
Touch your fingertip to your upper palate. The tongue should not snap off.
When raised, the tongue is round or square in shape.
The tongue is attached to the floor of the mouth.
The length of the frenulum with the tongue raised is more than 1 cm.

Any non-compliance with these requirements can be considered deviations from the norm.

Classification of types of short frenulum

There are 5 types of abnormal development of the jumper:

transparent, thin, slightly hinders the functionality of the tongue;
translucent, thin, when the tongue is raised, its end bifurcates in the form of a “heart”;
opaque, thick, when the tongue moves forward, its tip is tucked in, the back part is raised;
short, fused with the muscles of the tongue (observed in cleft palate and lip);
the frenulum is almost absent, closely intertwined with the muscles of the tongue.

If you suspect ankyloglossia, you should consult a dentist or orthopedist. The doctor will advise the optimal treatment method. Many parents are afraid of surgical intervention and doubt for a long time whether it is necessary to trim the frenulum.

Surgical intervention

Surgical intervention is indicated in the following cases:

problems with breastfeeding;
malocclusion;
tooth displacement;
incorrect pronunciation of sounds that cannot be corrected using classical methods.

The decision to perform an operation must be made jointly by several doctors: a surgeon, an orthopedist and a speech therapist.

Types of surgery

Depending on how the frenulum is trimmed, there are three types of operations.

Frenulotomy. The simplest type of operation. An incision on the bridle is made with scissors at a distance of 1/3 of the length of the bridge, closer to the lower teeth. First, the mucous membrane is dissected, then the cords. After bringing the sides of the mucous membrane together, a suture is placed every 3-4 mm.
Frenulectomy, or the Glickman method. The frenulum is fixed with a clamp, then cuts are made between the clamp, the lip and the mucous membrane on the side of the teeth. The edges of the wound are sutured.
Frenuloplasty, or Vinogradova's method. A triangular flap is cut and peeled off, the edges of the wound are brought together with sutures. Incisions are made from the transitional fold and interdental papilla. The triangle is then sutured to the remaining wound surface. There are also Limberg and Popovich frenuloplasty methods, similar in methodology, and plastic surgery of the short frenulum of the lip is also performed. Indications for surgery are orthopedic and orthodontic diseases.

How is the operation performed?

Before surgery, it is necessary to have your blood and urine tested. The frenulum in newborns is usually trimmed in the maternity hospital if the doctor has diagnosed an anomaly. Frenulotomy is possible up to 9 months and is performed under local anesthesia. Since at this time the frenulum has not yet acquired nerve endings and blood vessels, the operation is painless and bloodless. After this, the baby is immediately put to the breast. The rehabilitation process takes several hours.

For older children, the operation is performed in a clinic under local anesthesia. It takes 5-10 minutes. To prevent bleeding, use an electrocoagulator or electric scissors. The wound heals within 24 hours. After the operation, it is recommended not to eat too hot or hard foods for several days, and carefully monitor oral hygiene. IN in some cases frenuloplasty may be required.

Contraindications

Bridle trimming is not performed if at least one of the following cases is diagnosed:

oncology;
blood diseases;
infectious processes in the body and oral cavity;
stomatitis.

Classical treatment methods

Stretching exercises

To stretch the frenulum, including after surgery, simple exercises are used.

Extend your tongue forward and move it from side to side.
Try to reach the tip of your tongue to your lower and upper lips.
"Horse". Click your tongue, sucking it to the roof of your mouth and sharply throwing it down.
Place some jam on your baby's upper lip and ask him to lick it.
Open your mouth wide and stroke your palate away from your teeth.
Smile with your mouth open. Touch the tip of your tongue alternately to the upper and lower teeth.
Close your mouth and rest the tip of your tongue on one cheek, then on the other.
Let babies lick the spoon more often.
Close your mouth and stretch out your lips.
Stretch your closed lips into a smile.
Pull out your lips and try smacking.

Classes should be carried out 5 times a day for 5 minutes. Do the exercises often, but not for long. Long activities tire the child.

Technique for stretching the frenulum according to E. V. Novikova.

Speech therapy massage

A speech therapist may recommend massage to stretch the frenulum. It is carried out with absolutely clean fingers. Sometimes the doctor may wrap them in a sterile tissue. This procedure is not pleasant, but it can bring tangible results.

Pinch the bridle between your index finger and thumb and slide them along the bridge from bottom to top.
Place your middle and index fingers under your tongue so that the frenulum is between them. Use your thumb to press on the front of your tongue and gradually pull it outward. The middle and index fingers remain motionless.
With your thumb and forefinger, grab the tip of your tongue and pull it down and up. Then use your index finger to pull the bridge upward with force.
Place the cut edge of the pipette in the form of a ring on the tip of your tongue. Open your mouth and press the ring to the roof of your mouth. Shut your mouth. Repeat the exercise ten times three times a day.

A short frenulum should not cause parents to panic. Before deciding to trim the lintel, consult with several experts. If acute orthopedic or dental diseases are diagnosed, it is worth considering surgery. In other cases, rely on your doctor’s recommendations and your own capabilities. Classic types of treatment will require a lot of patience and effort. However, if you're willing to spend it, go for it. The baby's health is in your hands!

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:

Tongue - located under the tongue.
Upper lip - localized between the upper lip and the gum mucosa above the level of the central incisors.
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 importance In human 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 oral cavity 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 pronounce 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 frenulum of the 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 your 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:

Relax your tongue as much as possible and place it on your lower lip. Hold for 10 seconds in 3 sets.
Stick your tongue out of your mouth as far as possible. Fix in this position for 10 seconds. Repeat 3 times.
Extend your tongue and circle your lips with it.
Click your tongue for 10 seconds, imitating the clatter of horse hooves.
Open your mouth wide. Slowly run the tip of your tongue across the roof of your mouth, moving from your teeth to your throat.
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 for surgical treatment are possible:

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 a large number of questions about this procedure. We will consider the main ones below.

Why trim?

Too much small size Such folds 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 famous doctor Komarovsky are unanimous in the opinion that the short frenulum should be trimmed if it has a negative effect on the child’s ability to suck milk or pronounce individual 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.

More modern techniques is a laser dissection, due to which there is no need for sutures, 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 heal properly with the formation of rough scars, which will subsequently lead to an incorrect bite and unclear pronunciation of sounds.

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What is the frenulum of the tongue?

The frenulum is a septum that is located under the tongue and connects it to the oral cavity at the bottom. It is maintained in a certain position by a membrane in the sublingual region and is completely covered with mucous membrane.

The superior frenulum and the septum between the lower lip and gums provide movement of the lips for speech and chewing. The length of the frenulum in a newborn is 8 millimeters, and it does not interfere with normal speech and eating. If the frenulum is less than 8 mm, then this is considered a pathology and abnormal development of the organ.

A shortened lingual frenulum can interfere with normal tongue movement, causing severe cases the end of the frenulum is located under the tip of the tongue and tightens it. In such cases, even with the mouth closed, the tongue remains between the teeth.

Ankyloglossia or shortened frenulum of the tongue is often hereditary, with boys being most susceptible to this pathology.

Causes and symptoms of ankyloglossia in children

The main reason for the development of pathology is genetic predisposition. If one of the parents suffered from this disorder in infancy, then in 25% of cases there is a chance of ankyloglossia occurring in the newborn.

During the first trimester of pregnancy, all organs are formed. Infectious diseases of the expectant mother and intrauterine infections of the fetus suffered during this period can provoke the development of pathology. Smoking and drinking alcohol while pregnant may be one of the reasons for the abnormal development of the lingual septum.

Pregnant women over 35 years of age are at risk, provided this is their first pregnancy. Also plays an important role ecological situation, which contributes to the development of various abnormalities in the fetus.

To identify pathology, parents need to observe the newborn. With ankyloglossia, the following symptoms are noticeable in a child:

Trimming the frenulum of the tongue as the main method of treating ankyloglossia

If you have any of the above symptoms, you should contact medical care. The doctor will visually examine the child and make a diagnosis. There are two methods for treatment. The first is to stretch the child’s frenulum using special exercises. The second method consists of surgically trimming the frenulum of the tongue.

The procedure takes little time and is practically painless. It is performed by a surgeon or dentist. The operation is carried out using scissors, which are used to trim a small part of the frenulum of the tongue. Sometimes there are cases that the baby blood vessels are located very close and after the incision several stitches are required.

In order not to psychologically traumatize children during surgery, it is necessary to distract them with something interesting, for example, toys.

Usually, parents are very worried before the procedure and often raise the question of the need to trim the frenulum. The answer depends on the parents themselves, because the discomfort that children experience when feeding is more unpleasant than the cutting procedure.

The operation can be performed when the baby grows up, because with a shortened frenulum of the tongue, a trimming procedure is indispensable. The child will certainly speak poorly and experience discomfort.

The advantages of having the tongue frenulum trimmed in infancy include the least traumatic consequences. Newborns forget psychological experiences after half an hour after the operation, while older children will remember the procedure for the rest of their lives and will be afraid of doctors. also in younger age faster recovery and healing of injured tissues in the oral cavity occurs.

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Reasons for the formation of frenulum pathologies

Despite the fact that the reasons leading to the formation of a short frenulum are not fully understood, there are several factors influencing its development:

Hereditary predisposition. Doctors have noticed the fact that children whose parents have undergone cutting of the frenulum of the tongue also need correction of the tongue membrane.
Problems during pregnancy. A shortened ligament can develop in the embryo if it is adversely affected in the first three months of pregnancy. The formation process can be affected by viral diseases, taking medications, stress, working with harmful working conditions (paints, varnishes, chemicals).

Types of pathologies

The following types of pathological changes in the formation of the frenulum are distinguished:

The hypoglossal ligament is represented by a thin transparent membrane, but the mobility of the tongue is limited.
A thin frenulum, the anterior edge of which is closely attached to the end of the tongue. When it is lifted, the tip bifurcates into a heart shape.
The hyoid membrane is short and dense, attached close to the end of the tongue. Lifting the organ is difficult. When the tongue protrudes from the mouth, its tip turns inward and the back rises.
The frenulum is short and dense, fused with the muscles of the tongue. The mobility of the organ is severely limited.
The hypoglossal ligament is inseparably intertwined with the muscles of the tongue, which practically does not move.

A defect of the short hypoglossal ligament is detected almost immediately in infants. Trimming the frenulum of the tongue in newborns can be done right in the maternity hospital. After all, a baby with such a pathology will not be able to attach to the breast correctly and will often lose it during feeding. The volume of milk that he can absorb will be insufficient to satisfy him, and as a result, the baby will slowly gain weight.

Trimming the frenulum of a newborn's tongue will not cause the baby severe pain. It is performed without the use of anesthesia because the ligament has no nerve endings. To calm the baby and stop bleeding, it is applied to the chest. After surgery, there will be improvement in sucking and swallowing and normal weight gain.

What are the consequences of ignoring the problem?

For many parents, cutting the frenulum of the tongue sounds like a death sentence. But if you delay the operation, then in the future you will have to deal with the following problems:

improper development of the lower jaw;
bite distortion (open anterior or lateral, cross, oblique);
displacement of the dentition;
failure speech breathing, disturbances in physiological breathing, which leads to mouth breathing and recurring colds;
speech dysfunction (problems with the articulation of hissing, sonorant and other sounds of the upper row), as a result, inexpressive speech.

Trimming the ligament will relieve older children and adolescents from constant injury and tears to the frenulum, excessive salivation during speech, snoring and sleep apnea syndrome. This defect can cause emotional and behavioral problems.

Most often, short frenulum in children aged 3-6 years is diagnosed by a speech therapist or pediatric dentist. Advice should be sought if parents notice that the child is unable to lick the lips with the tongue, raise the tip of the tongue to the roof of the mouth, or run the tongue along the gums. You can try to stretch a slightly shortened frenulum with regular special exercises and massage. If exercises do not bring results, then after consultation with specialists, surgical correction may be prescribed. The operation is often performed before the age of 9 years (before the replacement of milk teeth with permanent ones).

Operation: types, how it is performed

If cutting the frenulum of the tongue in newborns is a painless process and does not require anesthesia, then at the age of 5 years the same intervention will require local anesthesia and suturing using self-absorbing materials. Abnormal frenulum placement can be corrected by one of three types of surgery:

Private clinics practice cutting the frenulum of the tongue with a laser. To do this, the sublingual membrane is treated with an anesthetic gel and an LED is directed at it, focusing a beam of light that literally dissolves the frenulum. This operation is seamless, since the laser, evaporating the tissue, immediately sterilizes the wound.

Postoperative period

Usually, there are no unpleasant consequences after cutting the frenulum. The sutures may cause some discomfort if the operation was performed without the aid of a laser. For several days, the child should talk as little as possible and limit his intake of solid food. After a week, nothing will remind you of the surgery.

However, parents should understand that cutting the frenulum of the tongue in children will not solve problems with speech and articulation of sounds. A subsequent course of speech therapy and massage cannot be avoided anyway. The child must be re-taught to speak the language and strengthen his muscles. A visit to the dentist will help correct bite problems.

Timely identification of a short ligament and subsequent trimming of the frenulum of the tongue will help to avoid undesirable consequences associated with the health and development of the child. Parents, be vigilant. The beauty and health of children is in your hands.

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IN different time the problem of a small frenulum in newborns was treated differently: at first, if necessary, it was cut immediately in the delivery room, and then they began to say that this was not a problem at all. What is the current situation with this issue?

Now that all pediatricians are promoting the need to breastfeed children, they have begun to pay attention to the problem of a short frenulum under the tongue in newborns. Special attention, since the correct organization of the breastfeeding process greatly depends on this. And no matter how scary it may sound, the only solution to this problem is cutting the frenulum of the tongue in newborns. In order to dispel the fears and doubts of parents, we will consider the main signs of a short frenulum in newborns and the optimal time when it is best to trim it.

Signs of a short frenulum in newborns

The frenulum is a thin ligament-septum between the tongue and the lower oral cavity, which normally reaches the middle of the tongue. If it is attached to the very tip of the tongue or is really too short, which limits its mobility, then it is then called short.

This can be determined by the following signs:

The baby cannot hold the breast in his mouth for a long time.
Feedings are inactive and take a long time.
The child does not eat enough and, as a result, has poor weight gain.
Smacking, chewing, or biting the nipples while feeding.
After feeding - frequent regurgitation and bloating.
The mother has pain during feeding, frequent lactostasis, and deformation of the nipple shape.

A short frenulum in newborns can be easily seen by simply looking into the baby's mouth - the frenulum attached to the tip of the tongue will bifurcate it in the shape of a heart.

womanadvice.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, constant 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. Usually, most of 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. A short cord has a negative effect on 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 individual sounds forces parents to see 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 surgery 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.

What causes a pip on the tongue?

Often parents do not know or do not pay attention to the fact that the child has an underdeveloped tongue bridge. Already after three to five years from birth, the consequences of this anomaly appear: incorrect pronunciation of a number of sounds, problems with the formation of taste and teeth. The frenulum in a newborn can also be shortened. The parents’ task is to consult a doctor in a timely manner if the symptoms of a sublingual cord defect are obvious, but the problem was not noticed by the maternity hospital doctors.

Causes of short frenulum of the tongue in children

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

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

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.

How to check a child's frenulum

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

Bridle cutting in babies

When is the best time to have surgery?

Photo - tongue frenulum in newborns

Video: Short frenulum of the tongue

A short frenulum under the tongue is a common pathology in newborns. With a strong degree of development of the defect, it has an extremely negative effect on the development of the child: it complicates breastfeeding, disrupts the structure of the dentition, and leads to problems with the speech apparatus.

In this text you can learn about the signs by which pathology can be identified and cured in the most painless way possible.

Signs of pathology

A congenital defect of the frenulum is detected by a number of signs. They are visible to the naked eye and are diagnosed by a doctor during the initial examination of the newborn.

The main one is the unusual shape of the tongue with the tip slightly pulled down. It looks a bit like a small heart.

There are secondary factors that manifest themselves during feeding in the baby and the mother:

The baby smacks his lips and releases the nipple, which increases the duration of the feeding session and, in general, it becomes quite difficult to feed the baby.
Without eating, the baby gains weight worse.
Due to poor nutrition, colic occurs more often in a child. He regurgitates food.
The pathology does not allow the newborn to hold the mother's breast correctly, which is why cracks and bite marks remain on the nipple, and less milk is produced.

If these symptoms appear, you should take a close look at the child.

What does a shortened frenulum look like?

Violation of the frenulum length can be understood in three ways:

Firstly, the baby cannot stick his tongue out of his mouth, only slightly raising and lowering its edge. To test this reflex, you can run your finger over your baby's lips. In a normal reaction, the baby sticks his tongue out quite far, moving it around his lips in search of mother's milk.
Secondly, the surest way to identify a small frenulum is to watch your child cry. When screaming, the tongue should rise strongly, and if there is a disease, only the very tip will lift up.
Third, a child with a frenulum defect cannot reach the palate with his tongue.

If these signs are not enough for parents to be convinced of the need for treatment, they can contact any pediatrician for a diagnosis.

The photo shows a short frenulum of the tongue

Causes of the defect

The most common cause of the defect, provoking half of the cases, is a genetic predisposition and hereditary factor.

Another reason is the use of hormonal medications and antibiotics by a pregnant woman. Moreover, the most dangerous period is the first trimester of gestation. This factor also influences the formation of other oral pathologies.

A certain motivating factor in the formation of pathology can be late pregnancy - after 35 years, but this is not at all necessary and has a negligible effect.

The exact causes of this problem have not been studied, so sometimes it appears even without obvious reasons.

What can pathology threaten and interfere with?

The anomaly harms not only the baby, but also the grown child.

Among the negative consequences, professionals highlight the most dangerous:

In general, despite the painlessness and absence of a threat to life, a short frenulum greatly affects the development of the baby and causes a lot of problems for an older child, so it needs to be eliminated as soon as possible.

Problems with breastfeeding

This consequence of the anomaly concerns not only the health of the baby, but also his mother. Therefore, we should talk about this in more detail.

The baby's anatomy is designed in such a way that he actively uses his tongue when latching on to the nipple. However, the short frenulum does not allow him to use this organ, so the gums and lips come into play.

Note! This causes a lot of stress on the chewing apparatus, which makes the baby tired. His jaw may tighten, and while feeding he will cling and bite the breast strongly, causing discomfort to the mother.

After such feeding, the nipple becomes as if pinched or beveled, like the edge of a purchased lipstick. Due to increased friction, a watery bubble forms on its front part, and sometimes the skin cracks, which is accompanied by severe pain.

Due to the weakened retention of the nipple in the mouth, the baby begins to grab onto it with all his might. Increased squeezing to express milk leads to pain, which is dampened by the nourishing fluid that moisturizes the breasts. Therefore, pain may not occur immediately, but some time after eating.

On the left is the correct position of the tongue. On the right - short frenulum of the tongue

Degrees of anomaly

In pediatrics, there are several degrees of pathology of the frenulum under the baby’s tongue:

Degree	Symptoms
I	Thinning of the frenulum up to a translucent state and its shortening, which prevents the normal mobility of the tongue.
II	A frenulum with a defect is attached close to the end of the tongue, causing it to resemble a heart when raised.
III	The short, thickened section of the frenulum is also located close to the edge, which is why the tongue bends in a slide when lifted.
IV	A massive cord penetrates the muscular structure of the tongue, which usually occurs in parallel with a cleft lip or palate.
V	The dense area of the frenulum almost does not appear against the background of the tongue and fuses with the muscles, severely limiting the latter’s ability to move (the so-called ingrained tongue)

Thus, the danger of pathology increases depending on the degree of limitation of tongue mobility.

Diagnostics

How to identify the problem yourself

The correct length of a baby's frenulum is considered to be 8 mm and above. To take the measurement, you should pull back the lower lip so that the baby opens his mouth. If the tongue is attached at the very edge and does not reach the lip, then most likely there is a shortening of the frenulum under the tongue.

For older people characteristic syndrome It is identified when problems are detected with pronouncing individual letters (usually a lisp) and you seek help from a speech therapist.

How does a doctor diagnose?

Diagnosis of pathology is carried out by collecting anamnesis and visual examination of the patient

There are many child health specialists who can diagnose frenulum shortening:

pediatrician;
surgeon;
neonatologist;
dentist;
orthodontist;
speech therapist.

Diagnosis of pathology is carried out by collecting anamnesis and visual examination of the patient. The Haselbaker test, which takes into account the size of the frenulum and the mobility of the tongue, can help determine the disease.

In particular, according to the doctor’s method, it is considered normal if the bridge is longer than 0.8 cm, and the baby can easily reach his lips with his tongue and can lift it to the sky.

Operation

Often the best way to correct a frenulum abnormality is to undergo surgery.

In what cases is this necessary?

Typically, surgery is prescribed for severe defects that make feeding difficult.

Surgical correction begins in the first days of the baby’s life. Typically, surgery is prescribed for severe defects that make feeding difficult.

An alternative method is non-interventional therapy. It involves classes with a speech therapist using a special technique, as a result of which the frenulum stretches and the mobility of the tongue improves.

Conservative treatment is prescribed to an older child when the first speech defects appear.

At what age is it better to have surgery?

The best time to trim the frenulum under the tongue is during the first few weeks of life.

The next period is 9 months after birth. In this case, the skin growth grows a little, so its dissection will require anesthesia.

Important! At the age of 5, the child begins to grow permanent chewing organs. Plastic surgery of the frenulum during this period will be productive, as it will allow you to avoid wearing braces.

After 5 years of age, surgical removal of the defect no longer makes sense, since the child develops stable pronunciation skills and chewing organs, taking into account the pathology. In such cases, an orthodontist or speech therapist provides conservative therapy.

When treatment is carried out without anesthesia

Surgery on newborns does not require anesthesia, since their blood vessels and nerve endings in the frenulum have not yet formed. In addition, the drugs included in painkillers can harm the baby’s body. In subsequent years, the procedure becomes painful and requires preliminary local anesthesia.

In general, the older the patient, the more painful and serious the surgery to cut the hyoid frenulum will be.

How to do it

Frenuloplasty is performed using several methods: using a scalpel, laser or scissors. Depending on the age of the patient, local topical anesthesia is used or not, or painkillers are administered.

How is rehabilitation going?

In newborns, regenerative processes in tissues occur much faster. A small incision heals literally 2-3 hours after the surgeon’s intervention. The procedure does not leave scars or other consequences, since the wound heals within the fourth hour of rehabilitation. To check the results, the baby is immediately given breastfeeding so that the mother can evaluate the changes.

After cutting the frenulum at an older age, rehabilitation takes a little longer:

First, the doctor will apply stitches, so the patient will need a follow-up appointment.
For 4-5 hours after surgery, the child should not eat or drink any drinks other than water.
To prevent infection, it is recommended to treat the oral cavity with antiseptics, which are recommended by the doctor.

Intervention after the age of 3 years may leave a small scar.

Operation options

There are only 3 options for surgery to correct the length of the frenulum:

Name	Description
Frenulotomy	This type of intervention is considered the simplest. The patient's frenulum is cut in the area of the first third of its length, counting from the gums. The doctor then tightens and sutures the edges of the tissue or does without it when the operation is performed on a newborn.
Frenulectomy	This method is also called the Glickman method. The difference from the first option is that before cutting the frenulum, the desired area is fixed with a clamp. This is done to accurately localize the point of penetration of the instrument.
Frenuloplasty	This operation is a little more complicated, since the doctor not only makes an incision, but also cuts out a small triangular flap from the frenulum, which is then sewn back on. This method not only lengthens the frenulum, but also, after removing excess mucous membrane, makes it thinner and more elastic. The total duration of the operation does not exceed 15 minutes, and the patient feels the changes the very next day. To prevent complications, doctors prohibit eating hot and solid foods during the next week.

After treating a baby, positive changes from the procedure appear almost immediately. The baby's appetite awakens and he no longer bites his breast.

Important! If the anomaly is corrected in a timely manner, it does not cause complications in speech and the chewing system.

However, if the frenulum is cut for children of kindergarten age, after plastic surgery it is necessary to undergo a course of treatment from a speech therapist and an orthodontist, since the intervention only eliminates the mechanical cause of problems with speech and chewing food.

If the patient has formed stable reflexes and a permanent dentition has been established, further correction will require appropriate therapy.

Is treatment for a defect always necessary?

In most infants, this pathology has only a minor effect on health, and sometimes is not diagnosed at all.

Typically, indications for surgery include serious developmental problems in the infant.

In most infants, this pathology has only a minor effect on health, and sometimes is not diagnosed at all.

If a defect is detected in a 5-year-old child, treatment is not prescribed. It will no longer be advisable, since it will not correct the bite and speech.

It is much more effective to correct the position of the teeth and develop the speech apparatus from the appropriate specialists.

Possible complications after the defect

Modern treatment does not cause complications.

However, if the situation remains unchanged, the risks of diseases of the oral cavity and respiratory system may increase:

gingivitis;
periodontitis;
increased salivation;
snore.

Probability of occurrence side effects from therapy today is considered negligible.

Short frenulum of the lip in a newborn

Sometimes shortening of the frenulum can also occur in the area of the upper lip. This anomaly is not considered dangerous as it does not affect nutrition or pronunciation. However, in some children, due to the defect, a diastema develops - an abnormally wide gap between the two front teeth of the upper row.

Surgical treatment of this deviation is not required, since it is eliminated with braces or independently when the upper canines erupt.