How to determine the frenulum of the tongue for a child. What does a short frenulum mean in a child. How is the operation

The frenum of the tongue is a membrane on the oral mucosa, which is located directly under 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 frenulum 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 is likely to arise, is it possible to cut the frenulum of the tongue for an adult?

Functions and signs of ankyloglossia

In the human mouth there are 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;
• creation of conditions for normal food intake;
• the formation of the correct bite;
• maintaining the functionality of the facial muscles.

Short frenulum of the tongue - a common phenomenon

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

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

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

Indications for the use of plastics

1. Difficulties with breastfeeding. This problem occurs in a quarter of all babies with a short frenulum. Due to the limited mobility of the tongue, the baby 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 frenulum of the tongue in a newborn can be diagnosed by a pediatric neonatologist in a maternity hospital. Already there may be a simple dissection of the sublingual or other frenulum.
2. Difficulties in pronunciation. Usually such a deviation is detected by a speech therapist. kindergarten. This is explained by the fact that the language, constrained in its freedom, does not allow to pronounce all sounds correctly. If left unattended, such a problem may subsequently persist as a speech defect. And then plastic frenulum of the tongue in adults will be their opportunity to correct their speech.
3. Orthodontic reasons. A short frenulum of the tongue can affect the curvature of the dentition, tilting the incisors inward, and also slow down the development of the lower jaw. In addition, this pathology greatly complicates orthodontic treatment.
4. Periodontal causes. A shortened frenulum can cause gingival recession, which will expose the root of the tooth and make it more vulnerable to disease and damage, as well as impair its stability in the gum.

Tongue without a short frenulum is mobile and comfortable

A lot of positive feedback on cutting the frenulum of the tongue in adults today speaks of the popularity of this 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 frenulum of the tongue, whose cutting in adults is carried out relatively infrequently, heals somewhat longer than in children. preschool age. But in general, plastic is considered the most acceptable from 5-6 years if it was not carried out in infancy in order to correct violations breastfeeding. During this period, the central incisors were already at least partially cut through, while the lateral incisors did not start, which simplifies the operation.

One of the surgical options

Contraindications and practices

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

These include:

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

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

Otherwise, it stops through breastfeeding. At an older age, the operation requires local anesthesia and is called frenuloplasty.

It is carried out in several ways:

1. Cutting. After dissection of the sublingual frenulum, retaining transverse sutures are applied to its edges.
2. Removal. After two triangular incisions, the frenulum disappears, and the remaining wound is sutured.
3. moving. Two incisions separate part of the frenulum, after which it is attached to the site of an artificially tapering wound.

Correction of a short frenulum of the tongue is an important procedure and it is worth deciding on it.

Cutting the bridle for an adult is still quite simple. The operation lasts no more than 20 minutes, and the sutures are made of biodegradable material and disappear on their own after a few days. In addition, modern technology allows you to use for the procedure laser correction. In the case of laser application, there is no bleeding and no need for suturing.

Complications after the operation, as a rule, do not occur. The rehabilitation period lasts no more than a week. However, for successful wound healing, several conditions must be met. In particular, it is necessary to observe daily oral hygiene, avoid hot and hard food for several days, as well as conduct special exercises for the facial and jaw muscles.

Short frenulum of the tongue and "Defects of Fiction". Is everything simple?

"Cutting" or Plastic?

The tongue is a mobile muscular organ involved in the formation of the food bolus, performing tactile, gustatory reception, but the main function of the tongue is articulation, that is, pronunciation. The frenum of the tongue (hyoid ligament) is a strand of the mucous membrane that connects the tongue and the bottom of the mouth, and can also be attached to the inner surface of the lower jaw. Its length in an adult is up to 3 cm. There are no norms for a growing child. The frenulum can be thin, translucent, or it can be thick and tight.

The shortening of the frenulum of the tongue characterizes its length and shape. Domestic dentistry defines the frenulum and the only option for correction is “cutting”. Abroad, the restriction of tongue mobility due to a short frenulum is called "ankyloglossia", which, in our opinion, is more accurate and objective.

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

Absolute signs: difficulty or impossibility of protruding and raising the tongue, licking the 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 restriction of the mobility of the tongue:

• Light - a length of more than 15 mm, combined with the presence of relative signs and accompanied by a violation of sound pronunciation. Can be corrected by a speech pathologist.
• Medium - up to 15 mm., absolute signs and / or relative signs. Surgical correction and/or speech therapy.
• Severe - 5-10 mm and absolute signs. Only surgical correction and mandatory speech therapy.

At what age can plastic surgery be done?

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

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

What is the difference between plastic and "cutting"?

Undercutting is the usual dissection of the strand. Frenuloplasty is an operation to correct the length with the obligatory imposition of self-absorbable sutures. A typical undercutting mistake is that the healing process is completely out of control. It will be painful for the child to move his tongue after the operation for several days. With his silence, he will limit the movements of the tongue, which often leads to reverse fusion, the formation of a rough scar. Z-plasty is used in cases of tight, thick, and not pronounced short frenulum, in which linear plasty is contraindicated.

When to trim the frenulum of the tongue and is it worth it

The frenum of the tongue is a fold-strand in the form of a leathery bow, which starts from the middle of the bottom of the tongue and goes to the middle of the base. lower gum. It performs the functions of additional attachment of a 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 frenulum of the tongue.

Why do you need a fold of skin under the tongue

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

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

1. The muscles of the oral cavity get tired very quickly while talking or eating.
2. Babies older than four years old begin to have problems pronouncing hissing, “l” and “p”, there are obvious difficulties with swallowing, breathing may be disturbed, an underdeveloped lower jaw may form, as a result, an incorrect bite. The anterior incisors may move back. A smile twists. Simply put, the appearance suggests that a person has problems.
3. With a short bridle, the gum is pulled down, the roots of the teeth are exposed and dental diseases develop.
4. Wearing prostheses can be difficult for the elderly, but the reason for this is not the frenulum itself, but the problems that have been aggravated throughout life because of it.

Plastic surgery of the frenulum of the tongue in adults and children is a full-fledged operation, so the need for it must be clearly justified.

As for children, without the conclusion of a speech therapist, there can be no talk of any operation. After all, there is often an opportunity to stretch the cord with a non-surgical method of logomassage - is it possible for a speech therapist and a surgeon to decide together. At the same time, it is necessary to accurately differentiate existing speech disorders, because the surgical treatment of a defect in dysarthria, ONR and psychomotor retardation can aggravate speech pathology.

How to check the hyoid frenulum

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

Pathology is diagnosed in 4.8% of the world's population. Approximately 3 times more common in men than women

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

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

Parents can independently very easily determine a short frenulum 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, there is no problem. If you have any difficulties, you need to see a doctor.

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

Why does pathology occur?

The anomaly is congenital and is inherited. Similar problems should have been observed in parents, grandparents.

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

Ankyloglossia occurs if:

• the mother during pregnancy suffered serious viral or infectious diseases with infection of the fetus;
• mothers who abused alcohol in the early stages of pregnancy give birth to children with such pathologies;
• the mother received an abdominal injury during pregnancy, for example, during a fall or bruise;
• in late pregnancy.

Types of anomalies

The defect is usually manifested by the fact that the frenulums 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. By itself, the bridle can be of the most common length.

Frenulum 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. Medium - 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, mandatory surgical correction is prescribed, followed by speech therapy.

What are the consequences of a short frenulum

The functioning of the language is impaired. As a result, normal bite formation does not occur and jaw development is delayed. Usually this deficiency is detected from the first days of a newborn's life.

Ankyloglossia manifests itself in difficulties in organizing GV. Babies with this anomaly are often malnourished because feeding takes longer and they get tired. As a result, the baby does not gain enough weight and subsequently, if no action is taken, it may lag behind in development.

Babies born with ankyloglossia may experience the following problems during breastfeeding:

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

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

Indications for surgery

Children with a similar pathology usually get used to the limitations of the language. It is not uncommon for the hyoid frenulum to stretch itself as it grows older. If a child has been diagnosed with such a problem, you can wait for some time to see if it disappears on its own. If this does not happen, you will have to consult a doctor.

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

1. Newborns - when there are problems with sucking.
2. Preschool children - with problems with pronunciation and diction.
3. Preschoolers and schoolchildren, if the growth of the lower jaw is inhibited due to a defect, due to which the incisors may begin to tilt inward.
4. Also, due to the high attachment of the hyoid frenulum, problems arise when wearing orthodontic structures.
5. For an adult patient, the need may arise during orthopedic treatment. The hyoid fold can provoke pulling off of removable dentures during chewing from the lower jaw.
6. Plastic surgery is also necessary in the preparation of implant prosthetics, otherwise reimplantitis may begin to develop - inflammation of the tissues around the implant, which sometimes leads to its loss.

In some cases, intervention may not be possible. Contraindications include:

• oncology;
• blood clotting pathology.
• infectious diseases.
• mucosal inflammation.
• unsanitized cavity: untreated caries and pulpitis.

Age restrictions

With the inconveniences detected during breastfeeding, plastic surgery should be carried out as early as possible - in the first days after birth. For a newborn, the frenulum is simply cut even in the hospital.

It is difficult to accurately determine the age of the child at which it is necessary to carry out an operation to correct the anomaly. 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 dissection, which subsequently will also have to be excised.
2. Others insist that the operation should be planned no earlier than 4 years, in case of obvious speech problems. However, you need to understand that plastic surgery will not immediately save the child from speaking problems, and after the operation, he will have to visit a speech therapist anyway to restore speaking skills.

There are no age restrictions for adults. Plastic surgery can be performed at any age.

Laser plasty of the frenulum of the tongue is the most sparing method for eliminating the defect

Ways to eliminate the disadvantage

To correct the anomaly, the following interventions are carried out.

Frenotomy

In newborns, the fold of the frenulum is a whitish tissue in which there are no blood vessels. When dissecting the fold, neither anesthesia nor suturing is used. In infants, the fold is incised with surgical scissors. Possible slight postoperative bleeding stops by itself when applied to the breast.

Frenuloplasty (frenectomy)

The older the child becomes, the more blood vessels and cords form, the frenulum becomes thicker and more powerful, so the dissection is performed under anesthesia and with suturing. When blood vessels have already appeared in the fold (for children over 2 years old), plastic surgery is prescribed under anesthesia. The operation is performed by several techniques:

1. Cutting the fold.
2. Removing a crease.
3. Changing the place of attachment.

Cutting is the easiest way, in which the fold is cut and the subsequent stitching of its lateral edges with the capture of deeper tissues.

In a traditional operation, the mucosal fold is cut, a submucosal flap is formed, and the attachment of the hyoid frenulum is transferred. At the end of the operation, sutures are applied.

laser method

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

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

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, medicines that accelerate healing are applied to the wound. The rehabilitation period is also short. Already after 2 the effects are no longer felt. Laser tongue frenuloplasty is a quick and easy solution to many problems.

Journal headings

Frenulum of the tongue- the hyoid ligament that attaches the tongue to the floor of the mouth. Ankyloglossia, that is, a short frenulum, is considered a small congenital developmental anomaly. In this case, the ligament starts too close to the tip of the tongue, sharply fixing it in front. Ankyloglossia can be accompanied by problems during breastfeeding, the development of speech and breathing.

Symptoms of tongue tie in newborns and older children

Ankyloglossia can be diagnosed at any age.

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

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

Symptoms of a short frenulum of the tongue in infants:

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

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

1. Organic type of dyslalia (difficulty pronouncing palatine, hissing and whistling 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. Periodontitis and gum recession.

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

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

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

1. Ask your child to stick their tongue out of their mouth. A child with a short frenulum cannot stick out the tongue or the end of the tongue tends to go down.
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 to the sides. Often the baby cannot run his tongue along the gums at all and will touch the tip to the sky.

With a visual examination of the oral cavity, the length of the frenulum can be estimated. Even in a newborn child, this figure is more than 8 mm. At the age of 5 years, the length of the frenulum should be more than 17 mm.

Signs of a short frenulum of the tongue are divided into absolute and relative:

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

Tongue restriction:

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

Indications for tongue trimming surgery

Cutting the short frenulum 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 restriction of the mobility of the tongue. In the case of moderate limitation, the expediency of the operation is determined by the attending physician. A mild degree is corrected therapeutically (classes with a speech therapist, speech therapy).

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

1. Severe degree of restriction of mobility of the tongue;
2. The average degree of restriction of the mobility of the tongue with the failure of therapeutic treatment;
3. Nipple latch disorders during breastfeeding, insufficient weight gain in baby;
4. Forming malocclusion;
5. Emerging displacement of the dentition;
6. The need for orthodontic structures (removable dentures);
7. The need for implants (dentures).

In the event that in infancy the child did not have problems with
eating, the dentition is formed correctly, and a speech therapist reports ankyloglossia for the first time, 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 frenulum of the tongue is amenable to therapeutic effects, and surgical intervention is not required.

Parents should remember that articulatory gymnastics and speech therapist 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 contraindications.

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

Trimming of the frenulum of the tongue at a younger age is usually limited to a simple incision (frenulotomy), in children over 5 years of age and in adults, a hyoid fold repair may be required.

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

The bite, diction and health of the teeth depend on the correct arrangement of this small organ. If the problem exists from birth, in infancy it manifests itself in the form of improper suckling and poor quality breastfeeding.

The frenulum 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?

A short frenulum of the tongue is scientifically called ankyloglossia. Scientists have not yet established exactly why such a developmental deviation occurs. Here are just a few of the most likely reasons:

1. The biggest factor in this case- hereditary. If the mother or father was diagnosed with a short frenulum, then the child's probability increases to 50%.
2. Violation of the formation of the hyoid septum can provoke toxicosis on early stage maternal pregnancy or viral and acute respiratory infections. Not the last role is played by medication, especially hormones and antibiotics.
3. Injuries to the mother's abdomen during pregnancy can affect the development of the child.
4. Another reason is late pregnancy. Older parents (after 35 years of age) may have children with too short a frenulum of the tongue.
5. Exposure to chemicals in any form - for example, work in conditions of increased toxicity, contaminated Environment bad habits (smoking, alcoholism, drug addiction).
6. Of great importance for the full development of the baby is the emotional state of the mother during pregnancy. Frequent stress can also affect the formation of the hyoid frenulum.

signs

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

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

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

Short frenulum in a newborn:

• feedings occur often and last a long time, while the baby stops to rest;
• when you give the baby a breast, he behaves uneasily - cries, arches;
• the baby is not gaining weight well;
• the child bites the breast when feeding;
• while eating, the baby "clicks" and clicks the tongue;
• there is a great risk that he will completely refuse the breast.

For 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 the fears:

• lower incisors turned inward;
• the tip of the tongue is divided in two, when pulled out, a recess 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 down, which makes the tongue look humpbacked;
• to swallow chewed solid food, you need to 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 his parents, reach out to the sky or upper lip

How is the functionality of a language defined?

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

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

The test was proposed 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 functionality of the jumper. 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 draw it from one edge of the mouth to the other. In this case, the tongue should move easily behind the finger.
2. The child needs to lift the tip of the tongue to the upper palate. When performing this action, there should be no difficulties.
3. Put your finger on the lower lip and move it to the baby's chin. The tongue should follow the finger and freely touch the lower lip.
4. Press the pad of your finger against the upper palate. When sucking, the tongue will be even and should contract from the tip to the palate.
5. Touch the tip of your finger to the upper palate. In this case, the tongue should not snap off.
6. Ask the baby to lift the tongue (see also:). In this position, it should acquire a rounded or square shape.
7. Invite the child to press the tongue down. If the development is going well, he will do it without difficulty.
8. The baby needs to raise the tongue. The length of the bridle should be more than 1 cm.

Deviation even in some of the listed parameters is considered an alarm. It is important to know that correction should be done at a very early 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 varieties:

1. Thin, transparent. The functionality of the language is only slightly restrained.
2. Thin, translucent. If you lift your tongue, its tip forks.
3. Thick, opaque. If you push your tongue forward, the back will be raised and the tip tucked in.
4. Short. The bridge fuses with the muscles of the tongue.
5. Practically absent. 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 anomaly and gives the necessary recommendations. This may be surgery or non-surgical measures.

Undoubtedly, deviation correction needs to be dealt with. The sooner you start this, the more problems you can avoid:

1. In an infant, feeding becomes problematic. The baby does not grasp the breast correctly, he is not good at sucking, when feeding, he publishes different sounds tongue, gets tired and stops to rest. However, the child still remains hungry, becomes restless, practically 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 the natural diet with an artificial mixture.
2. With a short frenulum 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 he moves to the common table, difficulties will be added when chewing and swallowing solid food. Plus, indigestion, belching, diarrhea, periodontitis, gingivitis.
4. The work of the respiratory system is disrupted. Because of this, sleep suffers and apnea (short-term cessation of breathing) is manifested. Breathing through the mouth begins to predominate, 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 spinal curvature.

What does the well-known children's doctor Evgeny 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 frenulum in a newborn, it is up to him to decide on the need for surgical intervention. 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 carried out in different ways.

Indications

There are cases when surgery is indispensable:

• critical situation with natural feeding;
• incorrectly formed bite;
• displacement of teeth;
• speech defects that cannot be solved conservatively.

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

Contraindications

Surgery for a short frenulum 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 before any operation, a complete examination is necessary. If prohibiting factors are not identified, surgical intervention is permissible.

Operation types

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

1. Frenulotomy. This is the simplest operation. The hyoid septum is cut with scissors at a distance of 1/3 of the length of the bridge closer to the lower teeth. Dissect first the mucous membrane, and then the strands. Then the edges of the mucosa are reduced and a suture is applied every 3-4 mm.
2. Frenulectomy (Glikman method). The frenulum is fixed with a clamp, after which incisions are made between the clamp, lip and 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 separated in the form 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, Limberg and Popovich's frenuloplasty can be called. Similarly, trim the short frenulum of the lip. This operation is done in the case of orthopedic and orthodontic diseases.

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

How is the operation going?

If a short frenulum was found in a child in the first days of life, the operation is done in the maternity hospital. Frenulotomy can be done up to 10 months of a baby's life. This uses local anesthesia. 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 of the baby, you need to attach 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 electrocoagulator or electric scissors. 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 hard foods, as well as to carefully observe oral hygiene. In special cases, frenuloplasty is required.

As practice shows, if the operation to cut the short frenulum was carried out no later than 9 months, the child will not have speech defects. In addition, after surgery, babies begin to eat better. Older children will need to work with a speech therapist and do exercises to stretch the hyoid bridge so that it does not grow back together. You will have to work on the pronunciation of sounds.

Traditional Treatments

Once a frenulum has been corrected surgically, various measures are needed to secure 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 surgical intervention.

Stretching exercises

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

• stretch the tongue and move it from one corner of the mouth to another;
• reach the tip of the tongue to the lower and upper lip;
• click your tongue, sucking it to the sky and abruptly tearing it down (you get a sound similar to the clatter of horse hooves);
• lick a drop of jam from the upper lip with a tongue;
• open your mouth wide and run your tongue across the sky away from the teeth;
• stretch your mouth in a smile and touch the tip of your tongue first with the upper and then with the lower teeth;
• close your mouth and in turn 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 at the same time smack them;
• let the baby lick the spoon.

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

Logopedic massage

A speech therapy massage gives a good result, 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 run along the jumper from the bottom up.
2. Grab the hyoid septum with your middle and index fingers and fix it, and with your thumb press on the anterior region of the tongue and slightly pull it outward.
3. Pinch the tip of the tongue with your thumb and forefinger and pull it up and down. Then with the index finger pull the bridle up with force.
4. Put a small ring on the tip of the tongue (can be cut off from a 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 that runs along the midline and connects the floor of the oral cavity with the lower surface of the tongue (encyclopedic dictionary of medical terms, 1984). Sometimes the terms lingual ligament, hyoid ligament are used. The function of the frenulum of the tongue is to fix the tongue to the soft tissues of the oral cavity, to prevent retraction of the tongue, glossoptosis, especially during the neonatal period. Normally, the frenulum 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 area excretory ducts sublingual salivary glands (Fig. 1). The free tip of the child's tongue by the age of 18 months should reach at least 16 millimeters. The measurement of the absolute dimensions of the frenulum of the tongue has not found wide application in clinical practice. It is believed that the length of the frenulum of the tongue during the mixed bite should be at least 21 mm, and the width should not exceed 4 mm.

Fig.1. Options for attaching the frenulum of the tongue are normal. The permissible place of attachment to the lower surface of the tongue is highlighted in black. Green - to the mucous membrane of the bottom of the mouth.

Tongue frenulum- one of the most common SMALL ANOMALIES OF DEVELOPMENT of the organs of the oral cavity. This pathology sometimes called ankyloglossia. Ankyloglossia (ankyloglossia) - an anomaly of development: shortening of the frenum of the tongue from Ankilos - (Greek, curved, curved) component compound 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 has not found wide distribution 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 frenulum of the tongue is diagnosed in 2.3-19% of the subjects, and in boys, significantly more often than in girls, a short frenulum of the tongue occurs with a frequency of 1: 300 in newborns. Such a significant scatter of statistical data indicates the fuzziness of the applied diagnostic criteria, different principles of classification. The length of the short frenum of the tongue is no more than 1.7 cm, but this does not always cause violations of the function of the tongue, especially if the frenulum is anatomically located correctly.

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

Clinical manifestations of a short frenulum of the tongue.

In the period of a 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 approximately 3 mm. the tip of the tongue is located between them. The mobility of the root of the tongue 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 closed lips, there is a visible tension of the mimic muscles of the perioral region. In the future, the infantile type of sucking and swallowing is replaced by somatic when the tongue is repelled from 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 frenulum, during tension of the tongue, its tip is bifurcated in the form of a stylized heart, the edges of the tongue rise (Fig. 2).

Fig.2. Short frenulum 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 forked.

The child cannot lick the upper and lower lips. The back of the tongue, when you try to stick it out, rises, the tongue becomes curved, "humped". A short frenulum starts from the tip of the tongue or in its anterior third and is attached to the mucous membrane of the alveolar process of the lower jaw (Fig. 3). There are variants of ankyloglossy, when the frenulum is attached in the region of the 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 " crow's feet» (Fig. 4).

Even with a short frenulum (less than 1.5 cm), if it is attached to the soft tissues of the floor of the mouth, functional disorders do not always occur - difficulty in sucking during breastfeeding and impaired sound pronunciation during the formation of phrasal speech.

Fig.3. Options for attaching the frenulum of the tongue in ankyloglossia. The place of attachment of the frenulum 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.

Rice. 4. A 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 "crow's foot". The back of the tongue bends when you try to lift it.

As a result of tongue stiffness caused by a short frenulum, occlusion anomalies may form, the first signs of which during the period of temporary occlusion is the turn of the central lower incisors to the lingual side.

Language functions.

Language functions 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 taste, temperature, tactile, pain. The pathology of the frenulum 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 alimentary functions - chewing, swallowing, sucking, licking, licking, cleaning the mouth (spitting). A short frenulum of the tongue may interfere with the implementation of these mechanical functions, mainly sucking. Licking and lapping are rudimentary alimentary functions for humans.

The tongue is one of the main articulators that provide the function of speech. Speech is inherent only to man, its physiological basis is second signal system. The pathology of the frenulum of the tongue does not affect the formation of speech in general, but only the formation of some sounds.

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

Sucking.

At present, the importance of the implementation of the sucking instinct during the neonatal period and breast (natural) feeding is beyond doubt - “... it is in natural feeding that the real ways and opportunities for achieving biological perfection within the framework of one’s own species, the implementation and adjustment of the genetic fund, species-specific forms of initial socialization ... The work of the muscular apparatus of sucking when feeding a child determines the occurrence of efforts and stresses that most adequately regulate the anatomical formation of the dentoalveolar system, the brain skull, as well as the sound reproduction apparatus ”(Vorontsov I.M., Fateeva E.M. Khazenson L.B., 1993 ).

Sucking is an innate unconditioned reflex (instinct), which is formed during fetal 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 through 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 baby's life, suckling is unconditioned reflex, gradually replaced by a mixed, and then by a conditioned reflex.

Unrealized sucking instinct often leads to various types obsessive-compulsive disorder, sometimes manifested 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 lips and gums, moreover, from below it is more than from above, the nipple is at the level of the soft palate and does not participate in sucking. At the same time, the palatine curtain descends. Tongue taking the form of a gutter descends along 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 provided 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 squeeze the chest, providing relaxation of the sphincters of the milk ducts. Thus, the alternation of negative pressure during suction and positive pressure during compression ensures a dosed and rhythmic flow of milk. 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 a bottle, the child makes mainly retracting movements, which provide the muscles of the cheeks and the translational movements of the tongue. In this case, the flow of milk is continuous.

Feeding difficulties in the neonatal period.

Contraindications to breastfeeding.

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

Child: Phenylketonuria, galactosemia, "maple syrup odor disease". Contraindications to early breastfeeding - Apgar score below 7.

Difficulties 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, alternation of breastfeeding and bottle feeding. Changes in the taste and smell of milk when eating certain foods and medicines.

Fig.5. Types of nipples. Difficulties or even impossibility during feeding causes a depressed, poorly extensible 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" is when the baby does not latch onto the breast, but sucks mainly on the nipple.

On the part of the child: the child's diseases, both acute (ARVI, rhinitis, etc.), and congenital, birth trauma, etc. The child's rapid fatigue during sucking is more often associated with neurological problems. The presence of microgenia, cleft palate create significant problems in 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 mother and child does not reveal any pathology. The terms "lazy suckers" and "hungry lucky" describe this problem quite accurately. According to I.M. Vorontsova (1993) in such children, the maturation of the hypothalamic centers of hunger may be slowed down.

In itself, the presence of a short frenulum of the tongue during the neonatal period and breastfeeding does not affect or slightly affects the quality of feeding. Especially if the short frenulum of the tongue is attached in the area of ​​the soft tissues of the floor of the mouth, without causing stiffness of the tongue. In this case functionality tongue necessary for sucking are not violated. Healthy children, with the right feeding technique and the absence of other reasons, adapt quite quickly.

The only exceptions are the extreme variants of ankyloglossia, when the frenulum of the tongue starts from the very tip and is attached to the top 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 ability to form speech. The articulators are underdeveloped, the larynx is located much higher than in 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 in the form of babbling, not connected by a conditioned reflex with primary irritants. By the end of the first year of life, the first words used by the child for the purpose of verbal communication with other people are formed. A second signal system is being formed. The child learns to form an image abstracted from the circumstances. Abstraction and systematization of complex concepts make it possible to create first a passive and then an active vocabulary. At the age of 2-3 years, the development of phrasal speech begins. 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 connected with the centers of auditory (Wernicke's center) and written speech, as well as with extensive mnestic fields in the frontal and posterior parts of the cerebral hemispheres, which provide the semantic and meaningful aspects of speech.

There are three critical periods in the development of speech. The first (up to 2 years) - 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. The third - (6-7 years) the beginning of the development of written speech. The influence of unfavorable environmental and hereditary factors (acute and chronic diseases of the child, CNS lesions, anomalies of articulators, insufficient socialization, etc.) can lead to speech development disorders.

Here are some definitions of speech disorders.

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

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

Alalia- the absence or underdevelopment of speech due to an organic lesion of the speech zones of the cerebral cortex in the prenatal or early period of a child's development.

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

Dyslalia- violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus. Synonyms: tongue-tied tongue, defects in sound pronunciation, phonetic defects, shortcomings in the pronunciation of phonemes. Dyslalia may be mechanical(wrong structure of articulators) and functional(no apparent anatomical cause).

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 and 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- cessation of verbal communication with others due to mental trauma.

Underdevelopment of speech- a qualitatively low level of formation of a particular speech function or speech system as a whole.

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

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

FFN(phonetic-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, caused by a short frenulum, does not affect the overall development of speech. A short frenum of the tongue can only contribute to the formation of some variants of dyslalia.

Treatment of patients with a short frenulum of the tongue.

Indications to surgical treatment.

1. During the neonatal period and breastfeeding.

Pronounced violations of sucking. The child is not gaining weight. Significant stiffness of the tongue with an extreme version of the shortening of the frenulum (goes from the tip of the tongue to the top of the alveolar process). At the same time, the child is somatically and neurologically healthy. Absence of reasons that make breastfeeding difficult on the part of the mother.

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 frenulum 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 - a violation of the pronunciation of certain sounds (mainly R, L).

Indications for surgical treatment are jointly determined by the dentist, speech pathologist-defectologist if it is impossible to “stretch” the frenulum of the tongue with the help of speech therapy massage and speech therapy is ineffective. At the same time, it is necessary to clearly differentiate the types of speech disorders, tk. surgical treatment of ankyloglossia with ONR, dysarthria, psychomotor retardation can significantly aggravate the existing pathology.

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

3. Indications for surgical treatment of patients with dento-maxillary anomalies and a short frenulum of the tongue are determined by the orthodontist. Malocclusion, caused, among other things, by the unfavorable influence of a short frenulum of the tongue, is 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 occlusion.

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

With local anesthesia, both application and infiltration, it is necessary to remember the phenomenon sublingual suction. The toxic or allergic effect of the anesthetic when it is injected into the sublingual region increases significantly. In addition, the bottom of the oral cavity 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 sections of the tongue reflexively affect the cardiovascular and respiratory systems.

The use of local anesthesia in operations for short frenums of the tongue 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 anesthetist, while it is necessary to remember the possibility of aspiration of blood and saliva during the operation.

Types of surgical treatment of patients with a short frenulum of the tongue.

With any option of surgical treatment of patients with a short frenulum of the tongue, a preliminary laboratory examination is necessary (clinical laboratory minimum - clinical blood, urine, ALT)!

Frenulotomy- dissection of the frenulum of the tongue (what is often called "cutting the frenulum"). The tongue is lifted with tweezers or the reverse side of the grooved probe at the site of attachment of the frenulum to the lower surface of the tongue. The bridle is cut with scissors. Seams are not applied. This type of operation is used in the neonatal period. Some authors, substantiating this technique, write about the so-called. "avascular zone" of a thin and transparent frenulum of the tongue in the neonatal period. We believe that with this type of frenulum of the tongue, surgical treatment during breastfeeding is not indicated, because. at the same time, there is no pronounced violation of the sucking function. We do not recommend using this method due to possible complications. Bleeding, despite the common 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 frenulum, cicatricial stiffness of the tongue (Fig. 6).

Rice. 6. Cicatricial shortening of the frenulum of the tongue. Child 5 years old. At the age of three months, a frenulotomy (without sutures) was performed to prevent speech disorders. Severe mechanical dyslalia. Forming progeny. Chronic desquamatous glossitis.

Frenuloplasty - local plastic lengthening of the short frenulum of the tongue.

There are two types of frenuloplasty.

First way. The bridle in the place of its attachment to the tongue is fixed with tweezers and cut 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. The tongue is pulled up and anteriorly by the ligature, while dissecting the frenulum at the place of attachment to the lower surface of the tongue to the mouth of the excretory ducts of the sublingual salivary glands. The underlying fibrous bands are dissected and the tongue is mobilized. The resulting diamond-shaped defect is sutured "on itself" with catgut. This operation option is V-Y variety plastics (Fig. 7).

Rice. 7. The diamond-shaped defect is sutured "on itself" while constantly pulling the tongue up and forward by the handle. If the frenulum is fan-shaped woven 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 one in that, additionally, after partial suturing of the surgical wound, plastic surgery is performed with the figures of counter triangular flaps 60 0 x60 0 .

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

Frenuloectomy - excision of the frenulum of the tongue. The frenulum of the tongue is wedge-shaped excised and sutured. A variant of frenuloectomy is laser ablation. The disadvantages of this method include the lack of language mobilization.

Postoperative period usually runs smoothly . In rare cases, anesthesia is required. Assign a sparing diet for one to 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 oral cavity of the child there are three frenulums - one on the tongue and two on the upper and lower jaws, which connect the mucous membrane of the lips and gums in the projection of the anterior incisors. The frenulum is a mucous cord that ensures the 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 process of sound formation, or even the impossibility good nutrition newborn.

Causes

In newborns, the frenulum of the tongue, which connects the floor of the mouth and the tongue, is of particular interest. Opening her mouth and raising her tongue to the upper incisors, it becomes clearly visible. It is difficult to say exactly why some children have a normal-sized frenulum, while others have a short frenulum, it is not yet known exactly. But still there are 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 born child will also be with a short frenulum. 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 is attached in the immediate vicinity of the root of the tongue, it is this position that is most physiological, and will not hinder movement.

Attachment of the mucous cord in the anterior third or at the very tip of the tongue is considered pathological, restricting the movements of the tongue. Such an attachment does not allow it to be lifted up or even stick out for proper attachment to the breast or sucking the bottle.

Symptoms

All symptoms can be detected immediately after the birth of the child, or after the first breastfeeding / bottle feeding, sometimes the diagnostic process is delayed. It is enough to take a closer look at the newborn, swiping the nipple of the breast or a finger along the cheek - a 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 movements of the tongue are limited - the first sign.

Also alarming symptoms will be smacking sounds during feeding, but at the same time, this may indicate improper attachment. The newborn often rests on the chest - after a few minutes of active sucking, the child refuses the breast, without having eaten. Therefore, babies with short frenulums of the tongue do not gain weight well - this, by the way, is also a symptom.

Diagnosis of a short frenulum of the tongue in a newborn

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

All diagnosis is reduced only to the collection of complaints and visual inspection - where the bridle is attached. If the diagnosis was not detected in the maternity ward, the pediatrician who came to patronage can notice the problem.

Complications

Complications and consequences can be distant and close. The latter include the lack of a full-fledged weight gain, developmental delay. To distant ones - a violation of the pronunciation of sounds. The tongue simply cannot reach the upper incisors, and the child may incorrectly pronounce many sounds, especially “r”, “l”, “d”, “n”, “t”, etc. In addition, the lack of adequate chewing load on the jaw, during feeding, it can cause improper 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. The newborn cannot fully suck either the breast or the bottle, gains weight poorly and interrupts to rest during feeding. These are the warning signs. It is impossible to correct the pathology on your own, only with a slight shortening of the frenulum, some exercises and tests can help, but only for older children - preschool. Otherwise, the treatment is surgical.

What does a doctor do

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

After the diagnosis is made, together with the mother, the frenulum is cut with special surgical scissors. It has no innervation, so anesthesia is not required. It is extremely important immediately after the incision to attach the baby to the breast so that he begins to actively suck - this is also important to calm the crumbs, they usually 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 frenulum significantly restricts movement, the baby cannot even stick out his tongue, will a more voluminous operation with self-absorbable sutures be required. The intervention requires local anesthesia. Fortunately, such cases in newborns are rare.

Prevention

There are no specific measures to prevent short frenulums - 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 a disease such as a short or long frenulum of the mouth in newborns. Specify what effective first aid should be. How to treat: choose drugs or folk methods?

You will also learn how untimely treatment of the disease can be dangerous - a short or long frenulum of the mouth in newborns, and why it is so important to avoid the consequences. All about how to prevent a short or long frenulum of the mouth in newborns and prevent complications. Be healthy!

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

Features of the disease

If a man is diagnosed with a short frenulum of the foreskin, this means insufficient length and low extensibility 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 mild to severe. Pathology code according to ICD-10 - N47 (Excessive foreskin, phimosis, paraphimosis).

A normal-sized frenulum, the tissues of which are elastic, perfectly stretches and does not interfere with the movement of the skin during intercourse. A short bridle does not allow the head of the penis to be exposed during an erection, which causes a lot of suffering to a man.

A short frenulum contributes to the shortening of sexual intercourse, leading to early ejaculation. More often, pathology occurs in a child from birth, but due to 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 expose the head. Pathology is combined with shortening of the frenulum. But by the age of 7, in 95% of children, congenital phimosis and other problems disappear. The remaining boys are diagnosed with a congenital form of a short frenulum.

Acquired forms of pathology also occur. There are many reasons for this state of affairs.

In teenagers or older men, shortening of the frenulum of the foreskin can happen when:

• Injury to the head of the penis against the background of hard sexual contact;
• Abuse of wearing tight underwear, trousers;
• Long-term 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;
• Transferring STIs - syphilis, gonorrhea, etc.

Often having diabetes men, 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 frenulum to shorten over time.

The photo shows a normal and short frenulum of the foreskin (from left to right)

How to know if the bridle is short?

The appearance of the penis outside an erection can be normal, so in boys the problem is detected only by chance, during a routine examination by a urologist or surgeon. But during the period of active sexual life, the symptoms of the disease become more pronounced. During an erection, a too short frenulum does not allow the penis to straighten sufficiently, sometimes the erection immediately disappears from tightness and pain. The head of the penis in a tense state looks down. 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 frenulum tissue, the stronger pain. Rough sexual intercourse can even lead to a rupture of the frenulum and the appearance of bleeding. With untimely first aid, it can be long and plentiful.

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

Objective symptoms of shortening the frenulum of the foreskin are:

• When pushing back the foreskin, the short part of the frenulum 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 complexes, and a sexologist, while there are violations and dysfunctions in the intimate sphere.
On the video about the causes and symptoms of a short frenulum:

Treatment

A complete cure is possible only by surgery, since it is not possible to stretch the skin of the frenulum with any drug. A frenulotomy operation is used - dissection of the short frenulum 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.

In 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 frenulum is transversely dissected, the artery is ligated, and 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, Z-shaped plasty is shown - dissection of the frenulum in the shape of the letter Z, followed by suturing of two triangular flaps.

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

Often, laser and radiosurgical types of frenulotomy are performed. They are produced in the same way, but instead of a scalpel, a laser beam or a radio knife is used. There is practically no bleeding during this type of operation. The disadvantage is the risk of wound dehiscence as the size of the penis increases during an erection.

The bandage after the intervention 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, while they do not forget to visit the doctor regularly. Be sure to take antibiotics, if necessary - painkillers.

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 lead sexual life until the wound is completely healed.
3. Up to 2 months after the operation, it is mandatory to use lubricants during sexual intercourse.

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

Consequences

Without surgery, complications may develop. So, due to constant injury, cracks appear on the skin of the penis, where the infection easily penetrates. The result is often a recurrent inflammatory process. Men with a short frenulum experience early ejaculation and other problems in intimate life.

Bleeding is a serious consequence sharp pain from rupture of the bridle. In this case, it is important to immediately stop the blood - press the head for 10 minutes, after taking a bath with disinfectant and apply a bandage. After such a complication, it is important to consult a doctor as soon as possible and perform the operation even before the growth of scars on the frenulum.