A frenectomy is a relatively common type of oral surgery performed to remove the frenum (frenulum), the band of tissue that connects the tongue to the floor of the mouth. In some cases, abnormalities of the frenum, restrict movement of the tongue, interfering with a patient's ability to eat or speak. The speech problem, known medically as ankyloglossia, has given rise to the colloquial expression "tongue-tied." In cases where an abnormality of the frenum, such as size or tightness, is adversely affecting speech and eating patterns, a frenectomy is typically performed to remove the band of tissue causing the problem.
In some cases, difficulties as a result of an abnormal frenum may resolve on their own with the help of speech therapy and tongue exercises; in others, a loosening, rather than an excision, of the frenum, may be all that is necessary to solve the problem.
Reasons for a Frenectomy
In most cases, problems with the frenum show up early in life. Though uncommon, some infants experience difficulty nursing because of the malformation. More typically, when the baby begins to speak at between 12 and 18 months of age, difficulties in articulation become evident. Children may also notice that they cannot stick their tongues out as far as others, and older children and adolescents may experience an unpleasant sensation when their tongues get wedged between their teeth.
Dentists are sometimes the first to notice the problem when they observe that the child's gum tissue is pulling away from the lower front teeth, creating premature periodontal difficulty. Sometimes, the problem is noticed even before the baby teeth erupt. Occasionally, the frenum is attached between the two upper front teeth, rather than the lower front teeth, causing permanent teeth to erupt in abnormal locations in the child's mouth. In such cases, a procedure called a labial frenectomy must be performed.
In certain situations, patients who have not experienced previous problems with the frenum, have difficulty when they are older and require dentures. The position of the frenum may interfere with the fit of the denture, requiring a surgical procedure later in life.
The Frenectomy Procedure
The procedure is usually performed under local anesthesia, with or without nitrous oxide. Because it is important that the patient remain still during the procedure, however, young children may have to be given general anesthesia. This procedure usually takes less than 15 minutes. Using a scalpel or a laser, the surgeon removes, or sometimes loosens, the frenum from beneath the tongue. While slightly more expensive, the laser procedure results in less post-operative bleeding and pain and a reduced need for sutures. If sutures are needed, the doctor may use dissolvable or indissoluble stitches to close the wound.
Recovery from the Frenectomy Procedure
Most patients recover well from the frenectomy procedure, experiencing only minor soreness afterwards. Patients may have to take over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) to relieve discomfort during the recovery period, which usually lasts for a week or two. The great majority of patients achieve completely restoration of tongue mobility so that eating and speech difficulties are resolved. For many patients, tongue exercises may be recommended to assist in, and accelerate, recovery.
During the recovery period, patients are advised to rinse with saltwater to keep the area clean, to brush and floss carefully around the affected area. If patients have been sutured with stitches that require removal, they will have to return to the dentist after a week or two to have them removed.
Risks of a Frenectomy
While a frenectomy is considered safe and non-invasive, the procedure, like all medical procedures carries some risks, including the risk of excessive bleeding or infection.
- Medline Plus
- National Institutes of Health
- National Institute of Dental and Craniofacial Research
- Centers for Disease Control and Prevention
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- U.S. Department of Health & Human Services
- U.S. National Library of Medicine