How to identify a child's tongue frenum. What does a short bridle mean in a child? How is the operation going

The frenum of the tongue is the membrane on the lining of the mouth that sits just below the tongue. It extends from the middle of the tongue to the gums of the anterior lower incisors, connecting it to the oral cavity in the lower jaw. This fold serves to hold the tongue when it is pulled to the side, which is why it was named that way.

There is an anomaly called ankyloglossia. With her, the bridle does not go from the middle of the tongue, but from its tip, which limits its mobility. If the operation was not performed in childhood, then the question may arise, is it possible to cut the frenum of the tongue in an adult?

Functions and signs of ankyloglossia

The human mouth contains not one, but whole three bridles: on the upper lip, on the lower lip and, in fact, on the tongue. All three serve to perform several functions at once, which include:

• formation of correct diction;
• normal functioning of the oral mucosa;
• creating conditions for a normal meal;
• the formation of the correct bite;
• maintaining the functionality of the facial muscles.

Short frenum of the tongue is a common phenomenon

About every twentieth person is born with a shortened bridle... Moreover, 75% of them are males. It is not so easy to independently determine whether the bridle is short or not, since there may be no visible signs.

Nevertheless, there are a number of indicators by which certain conclusions can be drawn:

• bending the tongue down when pulling it forward;
• violation of swallowing and sucking function;
• obstacles in the way of stretching the tongue completely;
• problems with bite formation;
• periodontal disease;
• the formation of a heart-shaped tongue when it is raised;
• violations of diction and correct pronunciation.

Indications for the use of plastics

1. Difficulty with breastfeeding... This problem occurs in a quarter of all babies with a short bridle. Due to the limited mobility of the tongue, the child is not able to properly grasp the mother's nipple, which, in the future, causes problems such as malnutrition and slow weight gain. As a rule, a short frenum of the tongue in a newborn can be diagnosed by a pediatrician-neonatologist in a maternity hospital. There may already be a simple dissection of the sublingual or other frenum.
2. Difficulty in pronunciation... Usually such a deviation is detected by a speech therapist of a kindergarten. This is explained by the fact that a language constrained in its freedom does not allow to correctly pronounce all sounds. If left unattended, such a problem can subsequently persist as a speech defect. And then the plastic surgery of the frenum of the tongue in adults will become their opportunity to correct their speech.
3. Orthodontic reasons... The short frenum of the tongue can affect the curvature of the dentition, tilting the incisors inward, and also inhibit the development of the lower jaw. In addition, this pathology makes orthodontic treatment very difficult.
4. Periodontal causes... A shortened frenum can cause gum recession, which will expose the root of the tooth and make it more vulnerable to disease and damage, as well as disrupt its stability in the gum.

The tongue without a short frenum is mobile and comfortable

The many positive reviews on trimming the frenum of the tongue in adults today speaks of the popularity of such a procedure. Mainly in connection with the development of prosthetics on implants, since ankyloglossia is able to disrupt the nutrition of the tissues surrounding the implant.

It is worth saying that the frenum of the tongue, whose cutting in adults is carried out relatively infrequently, heals a little longer than in preschool children. But in general, plastic is considered the most acceptable from 5-6 years, if it was not carried out in infancy in order to eliminate breastfeeding disorders. During this period, the central incisors were already at least partially cut, and the lateral ones did not start, which simplifies the operation.

One of the options for surgical intervention

Contraindications and practices

Like any other surgical operation, the correction of such a defect as a short frenum of the tongue in an adult has its contraindications... In most cases, these are pathologies and diseases of the body, which the doctor must be notified of before starting the procedure.

These include:

• chronic diseases of the oral cavity during their exacerbation;
• oncological diseases of the jaw tissues;
• infectious diseases of the body as a whole;
• blood clotting disorders;
• mental disorders;
• poor oral hygiene.

Dissection of the sublingual skin fold in infants is called frenectomy or frenulotomy, depending on the type of cuts. Since at this stage the bridle does not contain blood vessels, bleeding, as a rule, does not occur.

Otherwise, it stops by breastfeeding. In older ages, the operation requires local anesthesia and is called frenuloplasty.

It is carried out in several ways:

1. Cutting... After dissection of the sublingual frenum, retaining transverse sutures are applied to its edges.
2. Deleting... After two triangular incisions, the bridle disappears, and sutures are applied to the remaining wound.
3. Moving... Two incisions separate part of the bridle, after which it is attached to the site of the artificially narrowing wound.

Correction of a short frenum of the tongue is an important procedure and should be decided on

Cutting the bridle for an adult is still quite simple. The operation lasts no more than 20 minutes, and the stitches are made of biodegradable material and disappear on their own after a few days. In addition, modern technologies allow using for the procedure laser correction... When using a laser, there is no bleeding and no need for sutures.

As a rule, there are no complications after surgery. The rehabilitation period lasts no more than a week. However, several conditions must be met for successful wound healing. In particular, it is necessary to observe daily oral hygiene, refusal of hot and hard food for several days, as well as special exercises for the facial and jaw muscles.

Short frenum of the tongue and "Defects of fiction". Is it that simple?

Undercut or Plastic?

The tongue is a mobile muscular organ participating in the formation of a food lump, carrying out tactile, gustatory reception, but the main function of the tongue is articulatory, that is, pronunciation. The frenulum of the tongue (sublingual ligament) is the mucosal cord that connects the tongue and the floor of the mouth, and can also attach to the inner surface of the mandible. Its length in an adult is up to 3 cm. There are no norms for a growing child. The bridle can be thin, translucent, or it can be thick, tight.

The shortening of the frenum of the tongue characterizes its length and shape. Domestic dentistry defines a frenum and the only correction option is "undercutting". Abroad, the limitation of the mobility of the tongue due to the short bridle is called "ankyloglossia", which in our opinion is more accurate and objective.

How to determine the shortening of the frenum of the tongue?

Absolute signs: difficulty or impossibility of protruding and raising the tongue, licking lips, impaired pronunciation of lingual sounds - W, F, R, L, etc. Relative signs: bifurcation of the tip of the tongue, reversal of the central lower incisors.

There are 3 degrees of limitation of tongue mobility:

• Light - more than 15 mm long, combined with the presence of relative signs and accompanied by a violation of sound pronunciation. It can be corrected by a speech therapist.
• Average - up to 15 mm., Absolute signs and / or relative signs. Surgical correction and / or speech therapy.
• Heavy - 5-10 mm and absolute signs. Only surgical correction and compulsory speech therapy.

At what age can plastic surgery be done?

There is no age limit. The operation is performed according to indications or speech therapy recommendations. Most often it is carried out at the age of 3-5 years, when there is a rapid development of speech and preparation for school. "Undercutting" is done even in the hospital, when the baby cannot adapt to breastfeeding. After 6-8 years, it is performed under local anesthesia.

There are several main methods of surgical correction: linear plastic (hardware and surgical), V-plastic, Z-plastic. At the age of 3-6 years, it is difficult to find psychological contact with the patient and complete the intervention in full, therefore we recommend carrying out the manipulation under light anesthesia. At the same time, mental trauma is avoided, the treatment time is reduced to 15-20 minutes, and we achieve maximum results due to precise surgical techniques. All correction options are performed with the obligatory suturing of the wound.

What is the difference between plastic and "undercutting"?

Undercutting is the usual cutting of the strand. Frenum plasty is an operation to correct the length with the obligatory imposition of self-absorbable sutures. A common undercutting mistake is that the healing process is completely out of control. The child will have painful movement of the tongue after surgery for several days. With his silence, he will limit the movement of the tongue, which often leads to back fusion, the formation of a rough scar. Z-plasty is used in cases of tight, thick, and not pronounced short frenum, in which linear plasty is contraindicated.

When to trim the frenum of the tongue and should it be done

The frenum of the tongue is a fold-strand in the form of a leathery arch that starts from the middle of the bottom of the tongue and goes to the middle of the base of the lower gum. Serves as an additional attachment of the muscular organ, that is, the tongue. In a normal healthy position, it does not cause discomfort and is virtually imperceptible. If its location is incorrect, surgical intervention is required to correct the defect - plastic frenum of the tongue.

Why do you need a fold of skin under the tongue

• fixation of the tongue in the mouth;
• prevention of language sinking;
• prevention of the pathology of glossoptosis, leading to the sinking of the tongue and impairment of its functions, which is especially dangerous for infants;
• bite formation;
• purity of pronunciation of sounds;
• normal work of the facial muscles.

A fold-strand defect leads to many complications, which, in fact, are indications for plastic surgery of the frenum of the tongue:

1. The muscles in the mouth get tired very quickly when talking or eating.
2. Babies over four years old begin to have problems with the pronunciation of hissing, "l" and "r", there are obvious difficulties with swallowing, breathing may be impaired, an underdeveloped lower jaw may form, as a result - an incorrect bite. The front incisors may move back. The smile twists. Simply put, the appearance suggests that a person has problems.
3. With a short bridle, the gums are pulled down, the roots of the teeth are exposed and dental diseases develop.
4. In the elderly, it may be difficult to wear prostheses, but the reason for this is not the bridle itself, but problems that have been aggravated throughout life because of it.

Plasty of the frenum of the tongue in adults and children is a full-fledged operation, therefore the need for it should be clearly justified

As for children, without the conclusion of a speech therapist, no operation can be discussed. After all, there is often an opportunity to stretch the cord in a non-surgical way of log massage - is it possible that the speech therapist and the surgeon decide this together. At the same time, it is necessary to accurately differentiate the existing speech disorders, because the surgical treatment of the defect in dysarthria, OHP and delayed psychomotor development can aggravate speech therapy pathology.

How to check the hyoid frenum

In a quarter of all cases, the anomaly is determined in the maternity hospital in the first days of a baby's life, without special examination. This is because there are problems with GW.

Pathology is diagnosed in 4.8% of the world's population. In men, it occurs about 3 times more often than in women

At an older age, signs by which one can judge the presence of a problem:

1. The tip is strongly pulled towards the bottom of the mouth, which limits its functionality.
2. If the tongue is raised or extended, the tip seems to bifurcate (it cannot be made sharp at all), and if it is pushed forward, the tip begins to involuntarily bend downward.
3. Often it is difficult for children to even just lift the tongue up.
4. The child is not able to lick lips, ice cream, play wind instruments.

Parents can easily determine on their own a short frenum in a baby under 3 years old: you need to ask him to touch the upper palate with the tip. If he does it easily, no problem. If you have any difficulties, you need to see a doctor.

It is sometimes rather difficult to independently diagnose the pathology, since the symptoms can be erased with a slight shortening. In a maternity hospital, a neonatologist can identify an anomaly in a child. In preschool children, the defect is usually diagnosed by a speech therapist or dentist.

Why pathology occurs

The anomaly is congenital and inherited. Parents and grandparents should have experienced similar problems.

In addition, a defect may occur in those who were born with a congenital malformation of the mouth: for example, a split palate formed as a result of changes in the X chromosome.

Ankyloglossia occurs if:

• during pregnancy, the mother suffered from serious viral or infectious diseases with infection of the fetus;
• mothers who abused alcohol in the early stages of pregnancy give birth to babies with such pathologies;
• the mother suffered an abdominal trauma during pregnancy, for example, when falling or bruised;
• with late pregnancy.

Types of anomalies

The defect is usually manifested by the fact that the bridles are either short or attached abnormally.

Ankyloglossia

The essence of the anomaly lies in the non-physiological location of the fold: when the upper end is attached close to the tip of the tongue. The bridle itself can be of the most common length.

Frenum plastic surgery (except, of course, tooth extraction) is the most common surgical intervention in pediatric dentistry.

Short frenulum - dysarthria

Nature has determined that the length of the bridle should be 2.7-3 cm. If this is not the case, problems arise.

There are 3 degrees of violation of the length of the fold:

1. Light - more than 15 mm, which is accompanied by a violation of sound pronunciation. This degree of pathology can be corrected by a speech therapist.
2. Average - less than 15 mm. Speech therapy is possible, if it is ineffective, an operation is prescribed.
3. Heavy - length 5-10 mm. In this case, a surgical correction is required, followed by speech therapy.

What can be the consequences of a short bridle

The functioning of the language is impaired. As a result, there is no normal bite formation and the development of the jaw is delayed. Usually this deficiency is detected from the first days of a newborn's life.

Ankyloglossia manifests itself in difficulties in organizing HS. Babies with this anomaly are often malnourished because the feeding lasts longer and they get tired. As a result, the baby does not gain enough weight and subsequently, if measures are not taken, may lag behind in development.

Babies born with ankyloglossia may experience the following problems during hepatitis B:

1. Difficulty adhering to the mother's breast, which increases the likelihood of damage to the nipple.
2. Insufficient increase in weight, since the baby quickly gets tired and refuses breast milk before saturation.

With hepatitis B, the baby should help with the tongue to adjust the milk from the mammary gland towards the nipple. With ankyloglossia, this movement is difficult. With artificial feeding, it is easier for such babies to suck milk from a bottle. After switching to solid food, the baby usually does not feel any discomfort.

Indications for surgery

Children with this pathology usually get used to the limited language. It is not uncommon for the hyoid frenum to stretch itself as it grows. If a child has been diagnosed with such a problem, you can wait for some time to see if it disappears by itself. If this does not happen, you will have to see a doctor.

Parents should understand that often plastic surgery of the tongue frenum in children is a necessary operation, without which serious problems are possible as they grow up.

1. Newborns - when they have problems with sucking.
2. For preschool children - with problems with pronunciation and diction.
3. For preschoolers and schoolchildren, if due to a defect, the growth of the lower jaw is inhibited, because of which the incisors may begin to roll inward.
4. Also, due to the high attachment of the hyoid frenum, problems arise when wearing orthodontic structures.
5. For an adult patient, the need may arise during orthopedic treatment. The sublingual fold can provoke pulling off of removable dentures during chewing from the lower jaw.
6. Also, plastic is necessary when preparing implant prosthetics, since otherwise peri-implantitis may begin to develop - inflammation of the tissues around the implant, which sometimes leads to its loss.

In some cases, the intervention cannot be performed. Contraindications include:

• oncology;
• blood clotting pathology.
• infectious diseases.
• inflammation of the mucous membrane.
• non-sanitized cavity: untreated caries and pulpitis.

Age restrictions

In case of the inconveniences found in HS, plastic should be performed as early as possible - in the first days after birth. For a newborn, the bridle is simply dissected while still in the hospital.

The age of the child at which it is necessary to carry out the operation to correct the anomaly is difficult to determine precisely. There are 2 opinions:

1. Some believe that the operation should be done before speech therapy problems begin to develop. However, in this case, a scar may form at the site of the incision, which subsequently will also have to be excised.
2. Others insist that surgery should be planned no earlier than 4 years in case of obvious speech problems. However, you need to understand that plastic surgery will not instantly relieve the child of speaking problems and after the operation he will have to visit a speech therapist in any case to restore his speaking skills.

For adults, there is no age limit. Plastic surgery can be performed at any age.

Laser plastic surgery of the frenum of the tongue is the most gentle method of eliminating the defect

Ways to eliminate the deficiency

To correct the anomaly, the following interventions are performed.

Phrenotomy

In newborn babies, the frenulum fold is a whitish tissue that has no blood vessels. No anesthesia or suturing is applied when cutting the fold. In infants, the fold is dissected with surgical scissors. Possible slight postoperative bleeding stops on its own when attached to the breast.

Frenuloplasty (frenectomy)

The older the child becomes, the more blood vessels and cords are formed, the bridle becomes thicker and more powerful, therefore, the dissection is performed under anesthesia and with sutures. When blood vessels have already appeared in the fold (children over 2 years old), plastic is prescribed under anesthesia. The operation is performed by several techniques:

1. By cutting the fold.
2. Removing the fold.
3. By changing the attachment point.

Cutting is the easiest way, in which the fold is dissected and then seamed along its lateral edges with the capture of deeper tissues.

In traditional surgery, the mucous fold is trimmed, a submucosal flap is formed and the attachment of the hyoid frenum is transferred. At the end of the operation, sutures are applied.

Laser method

Laser plastic surgery of the frenum of the tongue has a number of undoubted advantages:

• no bleeding;
• no need for stitches - the wounds are immediately sealed and covered with fibrin;
• speed - manipulation takes 5-6 minutes;
• less pronounced pain effect;
• fast healing time.

In the process of working with a laser, the doctor directs the tip of the device to the fold, which forms a laser beam that dissolves it. After the operation, medications that accelerate healing are applied to the wound. The rehabilitation period is also short. After 2, the consequences cease to be felt. Laser frenulum surgery is a quick and easy solution to many problems.

Journal headings

Tongue frenum - the sublingual ligament, which attaches the tongue to the floor of the mouth. Ankyloglossia, that is, a short frenulum, is considered a small congenital malformation. In this case, the ligament begins too close to the tip of the tongue, sharply fixing it in front. Ankyloglossia can be accompanied by problems during breastfeeding, speech formation and breathing.

Symptoms of a short frenum of the tongue in newborns and older children

Ankyloglossia can be diagnosed at any age.

For the first time, the length of the frenum of the tongue is checked by a doctor in a maternity hospital. In the event that this pathology is diagnosed, in most cases, the bridle is dissected immediately.

Sometimes ankyloglossia is detected in children at an older age, or in adults, when symptoms of this developmental anomaly appear.

Symptoms of a short frenum of the tongue in infants:

1. "Smacking" sounds when feeding;
2. Biting the chest;
3. A large number of feedings on demand;
4. The child often drops the breast and rests, spends a lot of time at the breast;
5. Insufficient weight gain;
6. Whims at the chest;
7. Refusal to breastfeed.

Symptoms of a short frenum of the tongue in children after a year and adults:

1. Organic type of dyslalia (difficult to pronounce palatine, hissing and sibilant sounds due to limited mobility of the tongue);
2. Inclination of the incisors of the lower jaw inward;
3. Malocclusion;
4. Poor fixation of removable dentures and implants;
5. Paradontitis and gum recession.

Ankyloglossia can be diagnosed by a pediatrician
neonatologist, general pediatrician, dentist, surgeon, otolaryngologist.

Parents may suspect the child has a short frenum of the tongue and consult with a specialist.

At home, you can ask a child over 2-3 years old to complete small tasks to determine the length of the bridle.

1. Ask your child to stick his tongue out of his mouth. A child with a short bridle cannot stick out his tongue or ends the tongue tends downward.
2. Ask your child to raise their tongue to the sky. With ankyloglossia, a fossa forms at the tip of the tongue, the tongue rises more on the sides. Often the baby cannot run his tongue over the gums at all and will touch the tip to the palate.

By visual inspection of the oral cavity, the length of the frenum can be estimated. Even in a newborn baby, this figure is more than 8 mm. At the age of 5 years, the length of the bridle should be more than 17 mm.

The signs of a short frenum of the tongue are divided into absolute and relative:

Depending on the presence of signs of shortening and the length of the frenum, the degree of restriction of the function of the tongue is determined.

Limitation of tongue mobility:

1. Easy degree. The length of the bridle is more than 15 mm, it is combined with the presence of relative signs and is accompanied by a violation of sound pronunciation.
2. Average degree. The length of the bridle is less than 15 mm., There are absolute signs and / or relative signs.
3. Severe degree. The length of the bridle is 0-10 mm, there are absolute signs of shortening.

Indications for the operation to trim the short frenum of the tongue

Undercutting the short frenum of the tongue (frenulotomy) is a simple operation. It requires only local anesthesia and is rarely accompanied by profuse bleeding. Almost immediately after the intervention, you can eat, drink, talk.

Surgical treatment is necessary for severe limitation of tongue mobility. In the case of moderate limitation, the expediency of the operation is determined by the attending physician. An easy degree is corrected therapeutically (classes with a speech therapist, speech therapy).

Indications for the operation to trim the short frenum of the tongue:

1. Severe limitation of tongue mobility;
2. The average degree of limitation of the mobility of the tongue with the failure of therapeutic treatment;
3. Violations of the grip of the nipple during breastfeeding, insufficient weight gain in an infant;
4. Forming malocclusion;
5. Emerging displacement of the dentition;
6. The need for orthodontic structures (removable dentures);
7. The need to install implants (dentures).

In the event that in infancy the child did not have problems with
eating, the dentition is formed correctly, and the speech therapist first reports about ankyloglossia, it is recommended to first undergo a course of speech therapy (articulatory gymnastics).

Classes with a specialist during such treatment are aimed at stretching the hyoid ligament. In 90% of cases with moderate and mild ankyloglossia, the frenum of the tongue is amenable to therapeutic action, and surgical intervention is not required.

Parents should remember that articulatory gymnastics and speech therapist's consultations will be necessary for the child even after cutting the hyoid ligament.
Sometimes the planned surgical treatment of ankyloglossia has to be postponed due to the presence of contraindications.

1. Oncological diseases;
2. Diseases of the blood;
3. Acute infectious processes;
4. Stomatitis, gingivitis;
5. Focuses of infection in the oral cavity before sanitation.

Undercutting the frenum of the tongue at a young age is usually limited to a simple incision (frenulotomy), in children over 5 years of age and in adults, plastic surgery of the hyoid fold may be required.

The hyoid frenulum is a thin bridge that connects the tongue to the lower oral cavity. It should reach the middle of the tongue, however, in newborns, there is also a short bridle, which can be attached to the very tip of the tongue or be practically absent (then the tongue is almost not separated from the lower oral cavity). In the photo you can see what a normal bridle looks like.

The bite, diction and dental health depend on the correct structure of this small organ. If the problem is present from birth, in infancy it manifests itself in the form of inappropriate sucking and poor quality breastfeeding.

The frenum connects the tongue to the lower part of the mouth and is an important factor in the quality of articulation

Why is the hyoid frenulum short?

The short frenum of the tongue is scientifically called ankyloglossia. Scientists have not yet established exactly why such a developmental deviation occurs. Now they only name a few of the most probable reasons:

1. The biggest factor in this case is hereditary. If the mother or father was diagnosed with a short frenum, then the child's probability increases to 50%.
2. Violation of the formation of the sublingual septum can provoke toxicosis at an early stage of pregnancy of the mother or viral and acute respiratory diseases. Treatment with medicines, especially hormones and antibiotics, plays an important role here.
3. Injuries to the mother's abdomen during pregnancy can affect the development of the baby.
4. Another reason is late pregnancy. At age giving birth (after 35 years), children may be born with too short frenum of the tongue.
5. Exposure to chemicals in any form - for example, work in conditions of high toxicity, polluted environment, bad habits (smoking, alcoholism, drug addiction).
6. The emotional state of the mother during pregnancy is of great importance for the full development of the baby. Frequent stress can also affect the formation of the hyoid frenum.

Signs

What is the norm? A newborn child has 8 mm (may be longer, but not shorter). By 5 years of age - up to 17 mm. The free tip of the tongue should be 16 mm long at a year and a half. A speech therapist will be able to determine the pathology.

A speech therapist will be able to diagnose pathology in older children - visiting a specialist will not be superfluous

To find out if the development of the sublingual septum in your baby is correct, it will be problematic to use some kind of measuring devices. However, there are various external signs by which you can spot deviations.

Short frenulum in a newborn:

• feedings are frequent and long lasting, while the baby stops to rest;
• when you give the baby a breast, he behaves restlessly - crying, bending over;
• the baby is not gaining weight well;
• the baby bites the breast while feeding;
• while eating, the baby "claps" and clicks the tongue;
• there is a great risk that he will completely abandon the breast.

In older children and adults:

• bite defects;
• periodontitis;
• difficulties in fixing implants and prostheses;
• incorrect reproduction of hissing sounds, as well as "p", "l", "d", "t".

Various defects in the structure of the oral cavity can also confirm concerns:

• the lower incisors are turned inward;
• the tip of the tongue is divided in two; when pulled, a depression is noticeable on it;
• the tongue cannot touch the sky, lips or stick it out;
• the back of the tongue is raised, and the middle is pressed downward, which makes the tongue appear humped;
• to swallow chewed solid food, move it to the back of the tongue.

With a normal bite, the child is able to stick out his tongue, and at an older age, at the request of the parents, reach the palate or upper lip

How is the functionality of a language determined?

You can determine the length of the jumper with a special test. According to the indicators, the developmental anomaly can be of varying degrees:

• easy - a bridle more than 15 mm long, there are violations in the pronunciation of sounds;
• medium - the length of the bridle is less than 15 mm, all signs are present;
• heavy - up to 10 mm in length with all signs.

The test was suggested by the American professor Alison Hazelbaker in the book "Tongue-Tie" ("Tongue bridle"). When determining the length, it takes into account both the appearance and the functionality of the lintel. She also lists the parameters that normal development must meet:

1. You need to put your finger on the lower lip in the center and drag it from one edge of the mouth to the other. In this case, the tongue should easily move behind the finger.
2. The child needs to raise the tip of the uvula to the upper palate. There should be no difficulty in doing this.
3. Place your finger on your lower lip and move it to the baby's chin. The tongue should follow the finger and freely touch the lower lip.
4. Press your fingertip to the upper palate. When sucking, the tongue will be flat and should contract from tip to palate.
5. Place the pad of your finger on the upper palate. In this case, the tongue should not snap off.
6. Ask your baby to lift the tongue (see also:). In this position, it should take on a round or square shape.
7. Invite your child to press the tongue down. If development is going well, he will do it without difficulty.
8. The kid needs to lift the tongue. In this case, the length of the bridle should be more than 1 cm.

A deviation even in some of the listed parameters is considered an alarm signal. It is important to know that correction should be done at the earliest stage, since moderate and severe degrees will require much more effort and entail additional problems.

Using the developed test program, parents themselves can determine the functionality of the child's language

Kinds

The short bridle is divided into 5 types:

1. Thin, transparent. The functionality of the language is only slightly restrained.
2. Thin, translucent. If you raise your tongue, its tip forks.
3. Thick, opaque. If you push the tongue forward, the back will be raised and the tip is tucked.
4. Short. The bridge grows together with the muscles of the tongue.
5. Almost nonexistent. Interlacing with the muscles of the tongue is observed.

Medical consultation

The problem of ankyloglossia is dealt with by a dentist and an orthopedist. If you notice any deviations, contact a specialist. He accurately diagnoses the degree of the anomaly and makes the necessary recommendations. This can be surgery or non-surgical measures.

Undoubtedly, it is necessary to deal with the correction of the deviation. The sooner you start this, the more problems you can avoid:

1. In an infant, feeding becomes problematic. The baby does not correctly grasp the breast, he is not good at sucking, when feeding he makes different sounds with his tongue, gets tired and stops to rest. Nevertheless, the child still remains hungry, becomes restless, almost no weight is added. As a result, the mother produces less milk and there is a great risk that it will completely disappear and it will be necessary to replace natural nutrition with an artificial mixture.
2. With a short frenum of the tongue, the bite will be formed with violations. Because of this, speech function is significantly impaired and speech defects will certainly appear.
3. When the child has teeth and moves to a common table, difficulties in chewing and swallowing solid food will be added. Plus, indigestion, belching, diarrhea, periodontitis, gingivitis.
4. The work of the respiratory system is impaired. Because of this, sleep suffers and apnea (short-term respiratory arrest) appears. Mouth breathing begins to prevail, and this, in turn, leads to frequent colds.
5. The influence of ankyloglossia on the formation of posture has been scientifically proven. Be prepared for a curvature of the spine.

What does the well-known children's doctor Yevgeny Komarovsky say about the problem? He divides the consequences of this deviation into 2 groups: sucking and speech. When a pediatrician detects an abnormal formation of a frenum in a newborn, it is in his competence to decide whether surgery is necessary. At an older age, a speech therapist is engaged in correction.

Surgical intervention

The short bridle can be trimmed. This is a very common way to solve a problem, and often even the only one. Before agreeing or refusing, you need to know how justified it is, what contraindications it has and how this process is generally carried out. Plus, the operation can be performed in different ways.

Indications

There are cases when an operation is indispensable:

• critical situation with breastfeeding;
• malformed bite;
• misalignment of teeth;
• speech defects that cannot be solved in a conservative way.

To confirm the need for surgery, an examination by a surgeon, speech therapist and orthopedist is required. Only if the situation is hopeless will this decision be justified.

Contraindications

Surgical intervention with a short frenum of the tongue is prohibited when any of the diagnoses is confirmed:

• malignant tumors;
• blood diseases;
• any infection in the mouth or in the body;
• stomatitis.

Before the appointment of the operation, the baby's oral cavity must be examined for infectious lesions and stomatitis

As with any operation, you must undergo a complete examination. If no inhibitory factors are identified, surgical intervention is permissible.

Types of operations

There are 3 types of operations. They differ in the way they are carried out:

1. Frenulotomy. This is the simplest operation. The sublingual septum is cut 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, and then the cords. Then the edges of the mucous membrane are brought together and a suture is applied every 3-4 mm.
2. Frenulectomy (Glikman's method). The bridle is fixed with a clamp, after which incisions are made between the clamp, the lip and the mucous membrane from the side of the teeth. Then a suture is applied.
3. Frenuloplasty (Vinogradova's method). Two converging incisions are made from the transitional fold to the interdental papilla. The flap is detached in the shape of a triangle, and the edges of the wound are sutured. After that, the triangle is sewn to the remaining wound surface.

Of the less common techniques, one can name Limberg and Popovich frenuloplasty. Likewise, trim the short frenum of the lip. This operation is performed in the case of orthopedic and orthodontic diseases.

Any of the operations involves making an incision on the frenum of the tongue

How is the operation going?

If a short bridle was found in a child in the first days of life, the operation is done in the hospital. Frenulotomy can be done up to 10 months of the baby's life. In this case, local anesthesia is used. In such a short time, the bridge has not yet acquired nerve endings and blood vessels, so the operation is painless and without blood. At the end, the baby needs to be attached to the breast, and the healing process will last only a few hours.

For older children, the operation is also performed under local anesthesia, but already in the clinic. This procedure lasts only 5-10 minutes. Bleeding during incisions is prevented with an electrocautery or electric shears. It will take 1 day for the wound to heal.

For a few days after the operation, it is recommended to limit the consumption of hot and solid foods, as well as to observe thorough oral hygiene. In special cases, frenuloplasty is required.

As practice shows, if the operation to trim the short bridle was carried out no later than 9 months, the child will not have speech defects. In addition, babies start to eat better after surgery. Older children will need to work with a speech therapist and do exercises to stretch the hyoid bridge so that it does not heal again. We'll have to work on the pronunciation of sounds.

Traditional treatments

After the short frenum has been surgically corrected, various measures are required to consolidate the result. In this case, these are stretching exercises and speech therapy massage. By the way, the use of such techniques is recommended even when it is possible to do without surgery.

Stretching exercises

Classes are held 5 times a day and last 5 minutes. It is better to do them more often, but not procrastinate. We list the exercises for stretching the short frenum of the tongue:

• stretch the tongue and move it from one corner of the mouth to another;
• reach with the tip of your tongue to the lower and upper lips;
• click your tongue, sucking it to the sky and abruptly pulling it down (a sound similar to the clatter of horse hooves is obtained);
• lick a drop of jam from the upper lip with your tongue;
• open your mouth wide and run your tongue across the palate away from the teeth;
• stretch your mouth in a smile and touch the tip of your tongue first to the upper and then to the lower teeth;
• close your mouth and take turns to rest your tongue on the right cheek, then on the left;
• close your mouth and stretch your lips into a tube;
• close your lips and stretch them in a smile;
• stretch your lips and smack them at the same time;
• give the baby a spoon to lick.

Simple speech therapy exercises will help consolidate the postoperative result and develop good diction

Speech therapy massage

A good result is given by speech therapy massage, although it does not deliver pleasant sensations to the child. The doctor conducts the procedure with thoroughly washed and disinfected hands. What is speech therapy massage:

1. The bridle is clamped with the index and thumb. Then, with closed fingers, you need to draw along the jumper from the bottom up.
2. With the middle and forefinger, grab the hyoid septum and fix it, and with the thumb, press on the anterior region of the tongue and slightly pull it out.
3. Clamp the tip of the tongue with your thumb and forefinger and pull it up and down. Then with the index finger, forcefully pull the bridle up.
4. Put a small ring on the tip of your tongue (you can cut it off from the pipette). Then open your mouth and press the ring to the sky, then close your mouth. Repeat the exercise 3 times a day for 10 sets.

The frenulum of the tongue (frenulum linguae) is a fold of the oral mucosa running along the midline and connecting the bottom of the mouth with the lower surface of the tongue (Encyclopedic Dictionary of Medical Terms, 1984). Sometimes they use the terms lingual ligament, sublingual ligament. The function of the frenum of the tongue is to fix the tongue to the soft tissues of the oral cavity, prevent tongue retraction, glossoptosis, especially during the neonatal period. Normally, the frenum of the tongue extends from the middle of the lower surface of the tongue and attaches to the mucous membrane of the floor of the mouth in the region of the excretory ducts of the sublingual salivary glands (Fig. 1). The free tip of a child's tongue by the age of 18 months must reach at least 16 millimeters. Measuring the absolute dimensions of the frenum of the tongue has not found wide application in clinical practice. It is believed that the length of the frenum of the tongue during the period of changeable bite should be at least 21 mm, and the width should not be more than 4 mm.

Fig. 1. Variants of attachment of the frenum of the tongue are normal. A valid attachment point to the lower surface of the tongue is highlighted in black. Green - to the mucous membrane of the floor of the mouth.

Short frenum of the tongue - one of the most common SMALL DEVELOPMENTAL ANOMALIES of the oral cavity organs. This pathology is sometimes called ankyloglossia. Ankyloglossia (ankyloglossia) - developmental anomaly: shortening of the frenum of the tongue from Ankilos - (Greek, crooked, curved) a component of complex words meaning 1) "curvature", hook-shaped form 2) "stiffness or fusion of parts" and Glossa - (Greek. ) - language (encyclopedic dictionary of medical terms 1982). This term is not widely used in the domestic medical literature and clinical practice, although it reflects some clinical manifestations (curvature of the tongue and its stiffness).

According to various authors, a short frenum of the tongue is diagnosed in 2.3-19% of the subjects, and in boys it is reliably more often than in girls, a short frenum of the tongue occurs with a frequency of 1: 300 in newborns. Such a significant scatter of statistical data indicates the vagueness of the diagnostic criteria used, different principles of classification. The length of the short frenum of the tongue is no more than 1.7 cm, but at the same time, dysfunctions of the tongue do not always occur, especially if the anatomically the frenum is located correctly.

Etiologically, a short frenum of the tongue is often due to a hereditary predisposition. There is also information about the significance of intrauterine trauma to the frenum of the tongue (when sucking a finger).

Clinical manifestations of a short frenum of the tongue.

During the period of the toothless oral cavity (up to 6 months) with closed jaws, the tongue occupies the entire oral cavity, its edges extend beyond the gums. Normally, in the anterior part of the oral cavity, there is a gap between the gingival ridges of about 3 mm. the tip of the tongue is located between them. The mobility of the tongue root is small and increases to normal by 3-6 months. During this period, sucking and swallowing in a child infantile, i.e. when swallowing, the tongue is repelled from the closed lips, there is a visible tension of the facial muscles of the perioral region. In the future, the infantile type of sucking and swallowing is replaced by somaticwhen the tongue pushes against the palatal surface of the teeth and the anterior surface of the hard palate. During the formation of a temporary bite, the tongue is normally located behind the teeth.

With a short bridle during the tension of the tongue, its tip is bifurcated in the form of a stylized heart, the edges of the tongue are raised (Fig. 2).

Fig. 2. Short frenum of the tongue. The length of the bridle is 1.3 cm - less than the norm by 8 mm. The tip of the tongue is bifurcated.

The child cannot lick the upper and lower lips. The back of the tongue, when trying to stick it out, rises, the tongue becomes curved, "humped". The short frenulum starts from the tip of the tongue or in its anterior third and attaches to the mucous membrane of the alveolar process of the lower jaw (Fig. 3). There are variants of ankyloglossi, when the bridle is attached in the area of \u200b\u200bthe excretory ducts of the sublingual salivary glands, and then, changing direction, is woven into the mucous membrane of the alveolar process in the form of a “goose foot” (Fig. 4).

Even with a short bridle (less than 1.5 cm), if it attaches to the soft tissues of the bottom of the oral cavity, functional disorders do not always occur - difficulty in sucking during breastfeeding and impaired pronunciation during the formation of phrasal speech.

Fig. 3. Variants of attachment of the frenum of the tongue with ankyloglossia. The place of attachment of the frenum to the tip of the tongue and its anterior third is highlighted in black. Green - to the mucous membrane of the alveolar process and the transitional fold of the mucous membrane of the floor of the mouth.

Figure: 4. The short frenulum of the tongue is attached to the mucous membrane of the alveolar process in a fan-like manner - in the form of a “goose foot”. The back of the tongue bends when you try to lift it.

As a result of tongue stiffness caused by a short frenum, bite anomalies can form, the first signs of which during the period of temporary bite are the reversal of the central lower incisors to the lingual side.

Language functions.

The functions of the language can be divided into two large groups: sensory and motor (mechanical). In some animal species, the tongue plays a significant role in thermoregulation.

Sensitive functions include gustatory, temperature, tactile, pain. The pathology of the frenum of the tongue does not affect the sensitive functions.

The motor functions of the language, in turn, can be divided into alimentary, speech and aesthetic.

The tongue, as an organ of the digestive system, is involved in providing nutritional functions - chewing, swallowing, sucking, licking, licking, cleansing the oral cavity (spitting). The short frenum of the tongue can interfere with the implementation of these mechanical functions, mainly sucking. Licking and lapping are alimentary functions rudimentary for humans.

Language is one of the main articulators providing speech function. Speech is inherent only in humans, its physiological basis is second signaling system. The pathology of the frenum of the tongue does not affect the formation of speech in general, but only the formation of certain sounds.

The aesthetic meaning of language plays a significant role in the socialization of the individual. Various "teasers", showing language, are typical for people of different ages, social status, races and nationalities.

Sucking.

Currently, the importance of the implementation of the sucking instinct during the neonatal period and breastfeeding (natural) feeding is beyond doubt - “... it is in natural feeding that the real ways and possibilities of achieving biological perfection are laid within the framework of one's own species, the implementation and adjustment of the genetic fund, specific for the species, forms of initial socialization ... The work of the muscular apparatus of sucking when feeding a child determines the emergence of efforts and stresses that most adequately regulate the anatomical formation of the dentoalveolar system, the cerebral skull, as well as the apparatus of sound reproduction "(Vorontsov I.M., Fateeva E.M., Khazenson LB, 1993 ).

Sucking is an inborn unconditioned reflex (instinct), formed during intrauterine development. In an 18-week-old fetus, sucking movements of the lips are observed, at 21-22 weeks - spontaneous sucking, at 24 weeks - searching and sucking reactions. The sucking reflex is one of the most stable, the absence or significant suppression of which is extremely rare. Thus, the sucking reflex is observed even in mammals with aencephaly. Excitation from the receptors of the lips and tongue is transmitted along the centripetal nerves (trigeminal) to the sucking center, located in the bulbar region, the centrifugal nerves (trigeminal, facial, hypoglossal) transmit excitation to the tongue, chewing and facial muscles, which provide the act of sucking. In the first weeks of a child's life, sucking is an unconditioned reflex, gradually replaced by a mixed, and then by a conditioned reflex.

An unrealized sucking instinct often leads to various types of obsessive-compulsive neuroses, sometimes manifesting throughout life.

When breastfeeding, the act of sucking is divided into two stages - suction and compression. The child clasps the areola of the breast with his lips and gums, and more from below than from above, the nipple is at the level of the soft palate and does not participate in sucking. At the same time, the curtain of the palate is lowered. Tongue taking the form of a gutter descends with the lower jaw downward and backward, a muscle wave is formed, passing from the front to the middle part of the tongue, thus creating a negative pressure in the oral cavity - 2-4 mm. mercury column. Tightness is also ensured by transverse folds on the mucous membrane of the lips and palate, Bish's fat lumps in the cheeks. Then the lower jaw rises and the alveolar arches compress the chest, allowing the sphincters of the milk ducts to relax. Thus, the alternation of negative pressure during suction and positive pressure during compression ensures dosed and rhythmic milk flow. The tongue does not have an exclusively independent role in sucking, his movements are strictly coordinated with the movements of the lower jaw, chewing and facial muscles.

Bottle sucking is different from breastfeeding. When sucking on a bottle, the child makes mainly retraction movements that provide the muscles of the cheeks and the translational movements of the tongue. In this case, the milk flow is continuous.

Difficulty feeding during the neonatal period.

Contraindications to breastfeeding.

The mother has: especially dangerous infections (smallpox, hemorrhagic fevers, etc.), open form of tuberculosis, syphilis, decompensation of chronic diseases of internal organs, malignant neoplasms, acute mental illnesses, treatment with certain drugs. Contraindications to early attachment to the breast are operative delivery, large blood loss.

In a child: phenylketonuria, galactosemia, "maple syrup-smelling disease." Contraindications to early breastfeeding - Apgar score below 7.

Difficulty in breastfeeding.

On the mother's side: primary hypolactia, significant hyperlactia, abrasions, cracks, changes in the shape of the nipples (Fig. 5), improper feeding technique, alternating breastfeeding and bottle feeding. Changes in the taste and smell of milk when some foods and medicines are ingested.

Fig. 5. Types of nipples. Difficulty or even inability to feed is caused by a depressed, poorly expandable nipple. In such cases, a nipple corrector (usually a vacuum one) is used in the prenatal period. A long nipple can also affect the quality of feeding during the formation of the so-called. "Nipple sucking", when the baby does not grasp the breast, but mainly sucks on the nipple.

From the side of the child: child's diseases, both acute (ARVI, rhinitis, etc.) and congenital, birth trauma, etc. Fatigue of a child when sucking is more often associated with neurological problems. The presence of microgenia, a cleft palate creates significant problems when feeding. There is a category of children who suckle poorly and do not show anxiety from hunger from the very beginning of feeding. An in-depth examination of both the mother and the child does not reveal any pathology. The terms "lazy suckers" and "happy hungry" pretty accurately describe this problem. According to I.M. Vorontsov (1993) in such children, the maturation of hypothalamic hunger centers may be slowed down.

By itself, the presence of a short frenum of the tongue during the period of newborn and breastfeeding does not affect or slightly affects the quality of feeding. Especially if the short frenum of the tongue is attached to the soft tissues of the floor of the mouth, without causing stiffness of the tongue. In this case, the functionality of the language required for sucking is not impaired. Healthy children, with the correct feeding technique and the absence of other reasons, quickly adapt.

The only exceptions are the extreme variants of ankyloglossia, when the frenum of the tongue starts from the very tip and attaches to the apex of the alveolar process. In any case, the decision on surgical treatment is made only after examination by a neonatologist, pediatrician and other specialists.

Speech

At birth, a child has only the potential for speech production. The articulators are underdeveloped, the larynx is located much higher than that of an adult, the speech-motor analyzer is not able to provide accurate articulatory movements of the lips, tongue, etc. In the second month of life, the first articulatory movements appear, which appear in the form of babbling, not connected by conditioned reflex with first signal radiators. By the end of the first year of life, the first words are formed that are used by the child for the purpose of verbal communication with people around him. A second signaling system is being formed. The child learns to form an image abstracted from the circumstances. Abstracting and systematizing complex concepts allows you to create first a passive and then an active vocabulary. At 2-3 years old, the development of phrasal speech begins. The coordination of the functioning of the speech apparatus is provided by the cortical part of the speech-motor analyzer, located in the left hemisphere of the brain in the posterior part of the third frontal gyrus. The motor center of speech (Broca's center) in its work is associated with the centers of the auditory (Wernicke's center) and written speech, as well as with extensive mnestic fields in the frontal and posterior parts of the cerebral hemispheres, providing the semantic and content aspects of speech.

There are three critical periods in the development of speech. The first (up to 2 years old) is the formation of the prerequisites for speech, the foundations of communicative behavior. The second (2.5 -3 years) - the transition from situational speech to contextual. Third - (6-7 years) the beginning of the development of written language. The influence of unfavorable environmental and hereditary factors (acute and chronic diseases of the child, lesions of the central nervous system, anomalies of the articulators, insufficient socialization, etc.) can lead to impaired speech development.

Here are the definitions of some speech disorders.

Agrammatism - violation of understanding (the impressive side of speech) and use (expressive side of speech) the grammatical means of the language.

Agraphy and dysgraphia - impossibility (agraphia) or partial specific violation of the writing process (dysgraphia).

Alalia - the absence or underdevelopment of speech due to organic damage to the speech areas of the cerebral cortex in the prenatal or early period of the child's development.

Alexia and dyslexia - impossibility (alexia) or partial specific violation of the reading process (dyslexia).

Dislalia - violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus. Synonyms: tongue-tied, pronunciation defects, phonetic defects, phoneme pronunciation deficiencies. Dislalia may be mechanical (wrong structure of articulators) and functional (no apparent anatomical reasons).

Dysarthria - violation of the pronunciation side of speech, due to insufficient innervation of the speech apparatus. In mild cases of dysarthria, when the defect manifests itself mainly in articulatory-phonetic disorders, they speak of its erased form.

Stuttering - violation of the tempo-rhythmic organization of speech, due to the convulsive state of the muscles of the speech apparatus.

Mutism - termination of speech communication with others due to mental trauma.

Underdevelopment of speech - a qualitatively low level of formation of one or another speech function or the speech system as a whole.

OHR (general speech underdevelopment) - various complex speech disorders, in which the formation of all components of the speech system related to the sound and semantic side is impaired in children. ОНР can be I, II, and III levels. OHP can be complicated by dysarthria, rhinolalia, alalia, etc.

Rinolalia (nasal) - violation of the timbre of the voice and sound pronunciation, due to anatomical and physiological defects of the speech apparatus.

FFN (phonetic and phonemic underdevelopment) - a violation of the formation of the pronunciation system of the native language in children with various speech disorders due to defects in the perception and pronunciation of phonemes.

The stiffness of the tongue, due to the short frenum, does not affect the general development of speech. The short frenum of the tongue can only contribute to the formation of some variants of dyslalia.

Treatment of patients with a short frenum of the tongue.

Indications to surgical treatment.

1. During the period of newborn and breastfeeding.

Severe sucking disorders. The child is not gaining weight. Significant stiffness of the tongue with an extreme shortening of the frenum (goes from the tip of the tongue to the apex of the alveolar process). At the same time, the child is somatically and neurologically healthy. Absence of reasons that impede breastfeeding on the part of the mother.

The indications for surgical treatment are jointly determined by the dentist, neonatologist or pediatrician, neurologist, and other specialists, if necessary.

We believe that there are no absolute indications for surgical treatment of a child with ankyloglossia at this age. Especially when the short frenum of the tongue is attached to the soft tissues of the floor of the mouth.

2. During the formation of phrasal speech (from 2.5 years onwards).

Mechanical dyslalia is a violation of the pronunciation of some sounds (mainly R, L).

The indications for surgical treatment are jointly determined by the dentist, speech therapist-defectologist if it is impossible to "stretch" the frenum of the tongue with the help of speech therapy massage and the ineffectiveness of speech therapy. In this case, it is necessary to clearly differentiate the types of speech disorders, tk. surgical treatment of ankyloglossia with OHR, dysarthria, delayed psycho-motor development can significantly aggravate the existing pathology.

To carry out an operation with a short frenum of the tongue in order to prevent possible speech disorders, especially at an early age, we consider not only inappropriate, but also harmful.

3. Indications for surgical treatment of patients with dento-maxillary anomalies and a short frenum of the tongue are determined by the orthodontist. Disorders of the bite, due, among other things, to the unfavorable influence of a short frenum of the tongue, are characterized by the absence of a tendency to self-regulation. In such cases, surgical treatment is also indicated from a prophylactic point of view, starting from the period of formation of a temporary bite.

Anesthesia. We consider it unacceptable to conduct surgical treatment of patients with a short frenum of the tongue without anesthesia.

With local anesthesia, both application and infiltration, it is necessary to remember the phenomenon sublingualsuction. The toxic or allergic effect of the anesthetic when injected into the sublingual region is significantly increased. Moreover, the floor of the mouth is a powerful reflexogenic zone. Secretory and motor activity of the gastrointestinal tract can be inhibited or activated when exposed to the mucous membrane of the middle part of the tongue. Stimulation of the tip and lateral parts of the tongue reflexively affects the cardiovascular and respiratory systems.

The use of local anesthesia during operations for short tongue frenum is considered inappropriate at the age of 7-8 years and in children with various behavioral disorders, hyperactivity, etc.

The decision on the choice of the method of general anesthesia is made by the anesthesiologist, while it is necessary to remember about the possibility of aspiration of blood and saliva during the operation.

Types of surgical treatment for patients with a short frenum of the tongue.

For any variant of surgical treatment of patients with a short frenum of the tongue, a preliminary laboratory examination is required (clinical laboratory minimum - clinical blood tests, urine tests, ALT)!

Frenulotomy - dissection of the frenum of the tongue (what is often called "cutting the frenum"). The tongue is lifted with tweezers or the back of a grooved probe at the point of attachment of the frenum to the lower surface of the tongue. The bridle is cut with scissors. No stitches are applied. This type of operation is used during the neonatal period. Some authors, justifying this technique, write about the so-called. The "avascular zone" of the thin and transparent frenum of the tongue during the neonatal period. We believe that with this type of tongue frenum, surgical treatment during breastfeeding is not indicated, because while there is no pronounced violation of the sucking function. We do not recommend using this method because of the possible complications. Bleeding, despite the widespread belief about the "avascular zone" is possible and can lead to serious consequences. Long-term complications of frenulotomy performed without suturing include the formation of cicatricial shortening of the frenum, cicatricial stiffness of the tongue (Fig. 6).

Figure: 6. Cicatricial shortening of the frenum of the tongue. Child 5 years old. At the age of three months, a frenulotomy (without suturing) was performed to prevent speech disorders. Pronounced mechanical dyslalia. An emerging progeny. Chronic desquamatous glossitis.

Frenuloplasty - localplastic lengthening of the cortical frenum of the tongue.

There are two types of frenuloplasty.

First way. The bridle at the point of its attachment to the tongue is fixed with tweezers and dissected with scissors by about 2-3 mm. the resulting wound is stitched with catgut or other rapidly absorbable suture material. The remaining ends of the ligature are used as a holder. For the ligature, the tongue is pulled up and anteriorly, while dissecting the bridle at the place of attachment to the lower surface of the tongue to the mouth of the excretory ducts of the hyoid salivary glands. The underlying fibrous cords are dissected and the tongue is mobilized. The resulting diamond-shaped defect is sutured "on itself" with catgut. This variant of the operation is a kind of V-Y plasty (Fig. 7).

Figure: 7. The diamond-shaped defect is sutured "on itself" while constantly pulling the tongue up and anteriorly by the holder. If the bridle is fan-shaped into the mucous membrane of the alveolar process, you can additionally dissect it with an electrocoagulator at the point of attachment to the alveolar process.

The second method differs from the first in that, in addition, after partial suturing of the operating wound, plastic is performed with the figures of opposite triangular flaps 60 0 x 60 0.

When rough sutures are applied in the area of \u200b\u200bthe excretory ducts of the sublingual salivary glands, an acute retention of saliva may occur - the so-called. "Salivary colic". This rare complication associated with a violation of surgical technique develops within the first hours after surgery. In such cases, 1-2 sutures are removed and antibiotic therapy is prescribed to prevent sialodochitis.

Frenulectomy - excision of the frenum of the tongue. The frenum of the tongue is excised in a wedge-shaped manner and sutures are applied. A variant of frenulectomy is laser ablation. The disadvantages of this method include the lack of language mobilization.

Postoperative period generally runs smoothly . In rare cases, pain relief is required. Prescribe a sparing diet for one or two days, rinsing the mouth with antiseptic solutions. 3-4 days after the operation, you can start classes with a speech therapist, conduct special classes.

In the child's oral cavity there are three bridles - one on the tongue and two on the upper and lower jaws, connecting the mucous membrane of the lips and gums in the projection of the anterior incisors. The frenulum is a slimy cord that provides mobility of the lips or tongue, despite their small size and invisibility, they play a huge role. They provide normal nutrition, speech formation, etc. Their change in length and thickness is not a disease, but rather an anatomical feature that will interfere and cause malocclusion, the formation of sounds, or even the impossibility of proper nutrition for the newborn.

Causes

In newborns, the frenum of the tongue, which connects the floor of the mouth and the tongue, is of particular interest. Opening the mouth and raising the tongue to the upper incisors, it becomes clearly visible. It is difficult to say exactly for what reason some children have a normal size bridle, while others are short, until it is precisely known. But there are still theories, and the main one is the hereditary factor, if parents or close blood relatives had similar episodes, then with a high percentage of probability, the child born will also be with a short bridle. This is not a disease, but just a feature that is easily corrected, but it is important to notice it in time.

The length of the bridle is determined not by its absolute size, but by the place of attachment. Normally, it attaches in the immediate vicinity of the root of the tongue, it is this position that is most physiological, and will not hamper movement.

The attachment of a mucous cord in the anterior third or at the very tip of the tongue is considered pathological, restricting the movement of the tongue. This attachment does not allow you to lift it up or even stick it out for proper attachment to the breast or sucking the bottle.

Symptoms

All symptoms can be detected immediately after the birth of the baby, or after the first breastfeeding / bottle feeding, sometimes the diagnostic process is delayed. It is enough to look closely at the newborn, swiping the nipple of the breast or a finger along the cheek - the reflex will work, the baby will open its mouth wide and will look for the breast, trying to stick out its tongue to lay it under the nipple. If the movement of the tongue is limited - the first sign.

Smacking sounds during feeding will also be alarming symptoms, but at the same time this may indicate incorrect attachment. The newborn often rests on the breast - after several minutes of active sucking, the child refuses to breast, while not eating enough. Therefore, babies with short bridles of the tongue do not gain weight well - this, by the way, is also a symptom.

Diagnosis of a short frenum of the tongue in a newborn

When the first warning signs appear, it is necessary to seek help from specialists, as a rule, diagnosis occurs in the maternity hospital, after examining the newborn's oral cavity by a doctor.

All diagnostics is reduced only to collecting complaints and visual inspection - where the bridle is attached. If the diagnosis was not identified in the maternity ward, the pediatrician who came to the patronage may notice the problem.

Complications

Complications and consequences can be distant and close. The latter include the lack of full weight gain, developmental lag. To distant ones - a violation of the pronunciation of sounds. The tongue simply cannot reach the upper incisors, and the child can incorrectly pronounce many sounds, especially "p", "l", "d", "n", "t", etc. In addition, the lack of an adequate chewing load on the jaw, during feeding, it can cause abnormal development of the jaws - insufficient growth rates, which will subsequently affect the bite - teeth coming out of the dentition, crowding of teeth and other disorders.

Treatment

What can you do

The main task of the mother is to notice the problem in time. A newborn cannot fully suckle either a breast or a bottle, gains weight poorly and is interrupted during feeding to rest. These are alarming signs. It is impossible to independently correct the pathology, only with a slight shortening of the bridle some exercises and tests can help, but only for older children - preschool. Otherwise, the treatment is surgical.

What the doctor does

If the problem was diagnosed in the genital ward, then the correction is carried out there. All treatment consists in surgical treatment, namely in the incision of the frenum, so that its attachment becomes correct.

After the diagnosis is made, the bridle is cut with special surgical scissors together with the mother. It has no innervation, so no pain relief is required. It is extremely important to attach the baby to the breast immediately after the incision so that he begins to actively suck - this is important both for calming the crumbs, usually they do not like it when strangers carry out any manipulations with them, and to assess the sucking ability.

Only in rare cases, when a short bridle significantly restricts movement, the baby cannot even stick out his tongue, a more voluminous operation with the imposition of self-absorbing sutures will be required. For the intervention, anesthesia is required - local. Fortunately, such cases are rare in newborns.

Prevention

There are no specific prevention measures for short bridles - this is a congenital feature, not a disease. All preventive measures are reduced to the elimination and prevention of the consequences of a short frenulum of the oral cavity - the full development and weight gain of the child, the establishment of proper breastfeeding.

In the article, you will read all about the methods of treating such a disease as a short or long frenum of the oral cavity in newborns. Clarify what effective first aid should be. How to treat: choose medicines or alternative methods?

You will also learn what the danger of untimely treatment of an ailment of a short or long frenulum of the oral cavity in newborns can be, and why it is so important to avoid the consequences. Everything about how to prevent a short or long frenum in the oral cavity in newborns and prevent complications. Be healthy!

Some boys have a defect in the development of the external genital organs from birth - a short frenulum of the foreskin. Often, pathology is inherited. In some cases, the problem occurs already in adulthood, when a man suffers a number of diseases or trauma.

Features of the disease

If a man is diagnosed with a short frenulum of the foreskin, this means insufficient length and low elongation of the skin fold, which passes to the head from the foreskin. Such an anomaly is diagnosed in 5% of men and boys, while the severity of the disease varies from minor to severe. The pathology code according to ICD-10 is N47 (Excessive foreskin, phimosis, paraphimosis).

The normal size of the frenum, the tissues of which are elastic, perfectly stretches and does not interfere with the movement of the skin during intercourse. A short bridle prevents the head of the penis from being exposed during an erection, which causes a man a lot of suffering.

A short frenulum helps to shorten intercourse, leading to early ejaculation. More often, pathology occurs in a child from birth, but because of the described features, it is detected during the onset of sexual activity, in adolescence.

Causes of the pathology of the foreskin

Almost all newborn boys have physiological phimosis - the narrowness of the foreskin with the inability to bare the head. Pathology is combined with a shortening of the bridle. But by the age of 7, 95% of children have congenital phimosis and other problems disappear. The remaining boys are diagnosed with a congenital form of a short frenum.

Acquired forms of pathology are also found. There are many reasons for this condition.

In adolescents or older men, shortening of the frenum of the foreskin can happen when:

• Injury to the glans penis on the background of hard sexual contact;
• Abuse of wearing tight underwear, trousers;
• Long-term practice of traumatic sports;
• Damage to the foreskin by piercing, after the introduction of ointments and petroleum jelly;
• Transfer of infectious pathologies of the genital area - balanoposthitis, urethritis;
• Transmission of STIs - syphilis, gonorrhea, etc.

Often men with diabetes mellitus, against the background of circulatory disorders, suffer from recurrent balanoposthitis, in which the foreskin and skin of the head of the penis become inflamed. It also causes the bridle to shorten over time.

In the photo there is a normal and short frenulum of the foreskin (left to right)

How to find out if the bridle is short?

The appearance of the penis outside of an erection can be normal, so in boys the problem is revealed only by chance, during a routine examination by a urologist or surgeon. But during the period of active sexual activity, the symptoms of the disease become more pronounced. With an erection, a too short frenulum does not allow the penis to straighten sufficiently, sometimes from tightness and pain, the erection immediately disappears. The head of the penis looks down when tense. In such cases, the question arises: what to do?

During intercourse, if possible, a man has to look for a suitable position, otherwise there is pain, discomfort in the head area. The shorter the frenum tissue, the greater the pain. Rough sexual intercourse can even lead to rupture of the frenum and bleeding. If first aid is not provided on time, it can be long and abundant.

The urologist, andrologist or surgeon will help to diagnose the disease, it is recommended to contact him if such troubles are identified. The examination method is simple - already during the examination, the doctor can easily determine the pathology.

The objective symptoms of shortening the frenum of the foreskin are as follows:

• When the foreskin is pushed back, the short part of the bridle does not allow this to be done sufficiently;
• When you try to strongly displace the foreskin, pain occurs.

Sometimes a psychologist is involved in the treatment of a disease, if a man has developed complexes, and a sexologist, while in the intimate sphere there are disorders and dysfunctions.
In the video about the causes and symptoms of a short frenum:

Treatment

A complete cure is possible only by surgery, since it is not possible to stretch the skin of the frenum with any drug. Frenulotomy operation is used - dissection of the short frenum of the penis in order to restore its normal size.

The indications for surgery are:

• Congenital short frenulum;
• Scars on the bridle as a result of trauma, inflammation;
• The appearance of cracks, bleeding;
• Concomitant pathologies - phimosis, ejaculation disorders.

With acute infections, exacerbation of inflammatory processes, the presence of skin and purulent pathologies, the operation is performed only after complete recovery. Before the intervention, it is important to be tested for STIs, hepatitis, HIV, special preparation is not required. It is only necessary to shave off the hair on the genitals and thoroughly wash the genitals.

In childhood, the operation is not performed and the question of how to stretch the bridle does not arise. Usually, surgery is recommended for adolescents from 12 years of age and adults. In the first case, general anesthesia is used, in the second, local or general anesthesia. After disinfection of the penis area, the bridle is transversely dissected, the artery is tied up, the edges of the wound are sutured longitudinally. Only self-absorbable threads are used.

If there are scars, they are also removed (frenuloplasty). In some cases, a Z-shaped plastic is shown - dissection of the frenum in the shape of a Z letter, followed by stitching of two triangular flaps.

The duration of a frenulotomy is up to 20 minutes. With a combination of severe phimosis and a short bridle, circumcision is performed.

Laser and radiosurgical types of frenulotomy are often performed. They are produced in the same way, only instead of a scalpel, a laser beam or a radio knife is used. With this type of operation, blood is practically not released. The disadvantage is the risk of wound dehiscence when the size of the penis increases during erection.

After the intervention, the bandage should be worn for up to a day, then the wound should be opened to prevent infection from urine. The seams are treated daily with brilliant green, and do not forget to regularly visit the doctor. Be sure to take antibiotics, if necessary, pain relievers.

Important features of patient rehabilitation after frenulotomy:

1. When taking a shower, put a condom on the penis so as not to wet the wound.
2. Do not have sexual activity until the wound is completely healed.
3. Until 2 months after the operation, it is imperative to use lubricants during sexual intercourse.

In the video about the treatment of a short frenulum of the foreskin by performing a frenulotomy:

Effects

Complications may develop without surgery. So, due to constant trauma, cracks appear on the skin of the penis, where infection easily penetrates. The result is often a recurrent inflammatory process. Men with a short frenum have early ejaculation and other problems in their intimate life.

A serious consequence is bleeding and sharp pain from the rupture of the frenum. In this case, it is important to immediately stop the blood - press the head for 10 minutes, then run the bath with a disinfectant and apply a bandage. After such a complication, it is important to consult a doctor as early as possible and perform the operation even before the scars on the frenum grow.