Short frenulum of the tongue. Trim or stretch?

Unfortunately, even parents who are not privy to medical subtleties are familiar with the opinion that a short frenulum of the tongue in a child is the cause of speech therapy problems.
Why "Unfortunately"? Because it is ignorance of the material that leads to a clear decision - the bridle needs to be trimmed! Do you remember in the film “Pokrovsky Gate” the characteristic female surgeon with her famous phrase “Cut!.. without waiting for peritonitis”? So the same thing often happens to the poor bridle. However, as experience shows, there is not always only one way out. Not every case of the so-called “short frenulum” requires radical measures.

What is a short frenulum of the tongue?

The frenulum is a thin partition that connects the tongue and the lower oral cavity. Normally, the frenulum is quite elastic, stretches well and is attached to the tongue in its middle part.

An abnormal structure may be the location of the frenulum closer to the edge of the tongue or even at its tip. In addition, a significant decrease in its elasticity, that is, its ability to stretch, is possible.

So in fact, the concept of “short bridle” is not entirely correct. Therefore, there is no clear solution to this issue.

What results can I expect after plastic surgery?

Plastic surgery of the hyoid ligament, which is performed with high quality, ensures elongation of the tongue to an anatomically correct size. A surgical operation performed on infants makes it possible to shorten the period of rehabilitation of the child’s body.

Already 1-2 hours after completion of therapeutic manipulations, the baby can be applied to the breast. Older patients feel the positive effect of surgical treatment on days 3-4 as tissues are restored and signs of postoperative swelling are eliminated.

The tongue becomes more mobile, diction improves, and it becomes much easier to eat food.

The tongue is an important part of the masticatory and speech apparatus, the length of which is regulated by the hypoglossal ligament. This element of the oral cavity externally resembles a thin frenulum connecting the lower surface of the tongue and the floor of the oral cavity.

Too short a hyoid ligament disrupts the chewing process, leading to the formation of an incorrect bite and curvature of the front teeth of the lower jaw.

To make your tongue longer, you need to use the services of a speech therapist who will develop a set of exercises aimed at developing the muscles of this organ.

In the absence of a positive result, a radical method of therapy is used in the form of plastic surgery of the hypoglossal ligament, which is cut to surgically lengthen the tongue. The cost of surgery is 5,500 rubles.

What is the problem with the incorrect structure of the frenulum of the tongue?

In infants, an abnormal frenulum structure can cause difficulty sucking. In this case, the problem is solved in the maternity hospital by pruning. If the baby is still able to eat normally, doctors try to leave the situation alone, giving, as they say, time to grow. Indeed, in many cases, along with the growth of the jaw, the frenulum gradually stretches and takes on a normal shape.

In older children, a short hyoid frenulum creates some speech therapy difficulties:

Difficulties arise with the pronunciation of hissing sounds.
Correct reproduction of sonorants is not possible.

To pronounce the so-called upper lingual sounds, you need to raise the tip of your tongue upward. An insufficiently elastic bridle prevents this from being done.

However, it is very important to understand that it is not “responsible” for all speech problems. So if a child has a delay in speech development, syllables and sounds are “confused” in speech, a limited vocabulary or other problems, a short frenulum has nothing to do with it. The speech therapist will suggest effective methods of correction.

Contraindications

It is possible to make the tongue longer through surgery, but in the absence of medical contraindications.

This type of treatment is not used in the following cases:

the presence of any infectious disease that has an acute form of development;
severe hematological pathologies such as hemophilia, thrombocytopenia, leukemia;
chronic diseases of the oral cavity that are bacterial in origin (for example, glossitis, stomatitis, gingivitis);
osteomyelitis of the upper or lower jaw caused by infectious microorganisms;
all types of cancer, regardless of the type of tumor and its location;
severe pathologies of the central and peripheral nervous system;
all forms of caries, including complicated damage to tooth enamel.

The dentist may decide to postpone the surgical operation if, during a control examination of the oral cavity, it is determined that its sanitation was performed with obvious violations, and foci of an infectious process are observed.

Surgical dissection of the hypoglossal ligament is performed with extreme caution in people with diabetes. The presence of this disease can lead to severe complications that are associated with a long tissue healing process.

How to check if a child has a short frenulum

The presence of difficulties with the frenulum can be easily determined independently:

Open your mouth slightly and place the tip of your tongue in the area behind your upper teeth. In this position, the place of attachment of the frenulum is clearly visible. If it is not “where it needs to be,” it is difficult to lift the tongue up.
Pull your tongue forward. A short frenulum does not allow this to be done; in addition, the tip of the tongue visually looks forked
Open your mouth and try to touch your upper lip with your tongue and lick it. Difficulties with the bridle make this movement difficult to perform.

Please note: sometimes a child cannot cope with these exercises not because there is something wrong with the frenulum. The cause may be weak muscles of the articulatory apparatus. Take a clean handkerchief and try to help your tongue. If resistance is felt when moving, then the problem is still in the hyoid frenulum.

Symptoms accompanying dry mouth

In the absence of saliva, the body is unprotected, and therefore “attracts” many accompanying symptoms. Dry mouth is accompanied by: Thirst, a person cannot get drunk;

Feeling of “sticking together” of the tongue, gums and palate;

Bad breath;

The appearance of cracks and sores on the lips;

Tooth decay;

Difficulty swallowing food and water. The throat feels closed and hurts;

Irritation on the tongue;

Loss of taste in food;

Hoarseness.

With a constant lack of saliva, the digestive system begins to suffer, teeth and gums suffer, and problems with the ears and nasopharynx begin. At this time, it is dangerous to move along the street without a mask, as there is a high risk of catching any infection.

If you have dry mouth, the reasons may be natural.

Who to contact for help

Depending on the complexity of the situation, an orthodontist or speech therapist will help you cope with the problem. In any case, it makes sense to first get a consultation to decide what method of correction the child needs.

The dentist will carefully trim the frenulum, relieving the child of discomfort with one movement of his hand. However, recently doctors still recommend leaving surgical intervention as a last resort. An experienced speech therapist will offer a set of exercises and massage to stretch the frenulum.

Experts say that there are not many situations when the hyoid frenulum is absolutely unable to stretch. In almost all cases, a conservative approach achieves results.

Parents can evaluate the pros and cons of different approaches on their own.

Surgical method:

A quick, radical solution to the problem.
The operation is performed using anesthesia.
The healing process takes some time and is uncomfortable.
Dietary restrictions due to surgery.
It is advisable to maintain vocal rest for several days.
Psychological trauma in the child is possible.
After the operation, classes with a speech therapist are necessary to correct sound pronunciation.

Frenum stretching method:

Conservative, does not cause psychological difficulties in the child.
Effective in most cases.
Does not require changes to your usual routine.
It takes some time (several months).
Requires discipline and regular practice.

In any case, to resolve the issue, you need to consult a speech therapist.

Massage

You can do a simple massage to lengthen the tongue: grab the frenulum at the very bottom under the tongue with two fingers (index and thumb) and pull your fingers along it to the tip of the tongue. You must try to pull it, but you cannot use much force so as not to damage the thin fabric. In each session you need to do several of these techniques. Your fingers will quickly begin to feel the frenulum, and this action will not cause discomfort. By doing a massage 4-6 times a week, a person will be convinced that the frenulum has changed in length.

If the frenulum is less than 8 mm, then it is better to stretch it rather than operate. After surgery, a scar remains on the frenulum, which will reduce its mobility. In addition, a child who has undergone surgery will be afraid to do exercises so as not to experience the pain that he experienced during the operation.

Therefore, the best way to lengthen the tongue is to lengthen it with special exercises.

Bat

flickr/Jorge Brito M.

Scientists have been able to establish that the owner of the longest tongue among mammals is the bat (lat. Anoura fistulata). The length of her tongue is 8.5 cm, which is 3.5 times the length of her own body. This long tongue is necessary for the mouse to extract nectar from the Centropogon nigricans flower. And what’s interesting is that only these bats have adapted to extract nectar from this plant.

How is the penis lengthened through ligamentotomy?

The operation is performed under anesthesia. A skin incision is made in the middle of the scrotum, through this incision the surgeon gains access to the penile suspensory ligament, which is cut with a scalpel. The duration of the operation is 0.5-1 hour. Absorbable sutures are placed on the skin of the scrotum.

Carrying out the operation

The course of the operation includes several stages:

the patient is placed on a sterile couch;
spinal anesthesia is administered; monitor the body's reaction;
the surgeon makes a small incision;
palpates the connective ligament;
dissects it with a scalpel;
with slow and careful movements, stretches the penis to the maximum length of the ligament (it is different for each person);
the incision is sutured; a bandage is applied.

Ligamentotomy can be carried out according to the standard method, but in modern medicine another type of it is used - with the introduction of adipose tissue into the cavity to increase the diameter of the penis. Also, plastic surgery differs according to the type of excision - through the scrotum or pubis.

Excision in the scrotal area

This technique is considered the most modern and safe. If earlier access to the ligament was made through the pubis, now it is done through the scrotum, which opens up new possibilities:

The operation time is reduced to 10-20 minutes;
there is no scar;
soft tissue trauma decreased;
it became possible to perform surgical manipulations with a large amount of fatty tissue;
maximum painlessness after and during surgery.

Features of the procedure:

the skin is cut in the area of the scrotum (the upper part of the seminal sac), after which the soft tissues are pulled apart;
access to the ligamentous apparatus is opened;
the superficial sling-shaped ligament is cut;
the suspensory ligament is highlighted;
hemostasis is performed.

During scrotal excision, the surgeon pays attention to the mobilization of the ligaments located next to the branches of the dorsal vein and the spermatic cords.

Dissection in the pubic area

This is the first method of penis enlargement that was used. Its distinctive feature is the following:

excision is made in the pubic area;
large scars remain;
high level of soft tissue trauma;
difficulties in operating if the patient is overweight;
long rehabilitation period;
the formed scar in many cases does not allow the penis to fully take the upward direction.

Differences between techniques

Pain sensations with these two methods differ: with the first option, exit through the scrotal area is characterized by safety and painlessness for the patient, but certain difficulties for the surgeon. In the second option, it is easier for the doctor to excise the ligament through an incision above the pubic area, but this promises pain for the patient.

Plastic surgery is done under local anesthesia. The duration of the operation is about 50 minutes. Upon completion, a bandage is applied to the postoperative area. The sutures are removed after 2 weeks.

Rehabilitation after ligamentotomy. Extender

An extender is a device that is a prerequisite after ligamentotomy, without which the postoperative effect will not be observed, and the operation will be in vain.

The device must be used for more than 3 months for 4 or more hours daily. It is generally accepted that most of the lengthening process occurs between the third and sixth months.

Possible complications

Plastic surgery of the frenulum is a simple operation, but still it does not exclude the occurrence of complications:

Development of the inflammatory process. This complication is most likely, since the oral cavity is filled with various microorganisms and can cause infection. In this case, symptoms such as fever, local swelling, suppuration and pain are usually observed.
Soreness. This consequence is normal. It is associated with soft tissue injury and can be aggravated by eating and drinking. In these situations, it is recommended to resort to the use of painkillers.
Formation of a rough scar. This consequence of the operation is the result of refusal to perform tongue exercises.
Increased body temperature. This symptom is a normal variant in children. If present, anti-inflammatory drugs may be prescribed. Body temperature should return to normal in 2-3 days. If this does not happen, then you should contact a specialist.
Discomfortable sensations in the presence of stitches. Negative feelings usually disappear after a couple of days.
Smacking in babies. The symptom is alarming, as it may indicate improper latching of the breast or nipple. Smacking that does not disappear after 3 days indicates a medical error.
Seams coming apart. To avoid such a complication, it is necessary to ensure that the child does not fall or talk too much and actively. Also, you should not look into the child’s mouth, pulling the tongue too far. If the stitches come apart, you should immediately consult a doctor.
Formation of white plaque on the wound surface. Do not be alarmed, plaque is not pus, but indicates epithelialization. But there should be no swelling, fever or other symptoms of poisoning. The plaque does not require cleansing; it will disappear on its own by the time it is completely healed.
The tongue will remain numb and swollen for some time after the procedure. This is due to the fact that the effect of the anesthetic has not yet completely worn off. All these symptoms disappear within one day.

Parents of small children and adult patients should not worry about plastic surgery of the lingual frenulum. This procedure does not pose a health hazard and is very easy to tolerate. You can go to the World of Dentistry clinic with a “light” heart, since we employ qualified surgeons who know their business.

Is it worth performing a ligamentotomy?

So, to do or not to do? Not every man can decide to have a ligamentotomy. Firstly, this is a responsible decision, and secondly, it is quite expensive. In the Russian Federation, the cost of ligamentotomy is 30,000-90,000 rubles; this difference is determined by the qualifications of the plastic surgeon, the rating of the clinic and the price of the extender.

For obvious reasons, any patient-respecting urological center that performs ligamentotomy provides detailed information about this intimate operation on its website. Plastic lengthening of the penis by cutting the suspensory ligament is considered a simple and relatively safe operation. But no clinic will give an absolute guarantee. Therefore, the choice is yours - to have surgery or try to solve the problem not so radically.