Short frenulum in infants how to determine. A child has a short hyoid frenulum: methods of diagnosis and correction. Treatment with a laser

The frenum of the tongue (frenulum linguae) is a fold of the oral mucosa that runs along middle line and connecting the bottom of the mouth with the lower surface of the tongue ( encyclopedic Dictionary 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 region of the excretory ducts of the 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 is sometimes called ankyloglossia. Ankyloglossia (ankyloglossia) - an anomaly of development: shortening of the frenulum of the tongue from Ankilos - (Greek, curved, curved) an integral part of 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 examined, 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 a "crow's foot" (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 that 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 of obsessive-compulsive disorder, sometimes manifesting throughout life.

When breastfeeding, the act of sucking is divided into two stages - suction and compression. The child clasps the areola of the chest with lips and gums, and 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 not sufficiently developed, 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 (Brock'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 speech) - various complex speech disorders in which the formation of all components of the speech system related to the sound and semantic side is impaired in children. OHP can be I, II, and Level III. 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 the ineffectiveness of speech therapy. 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, plasty is performed with 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.

Approximately 30% of children have a frenulum defect in newborns (ankyloglossia). In most cases, the defect is detected even in the hospital by doctors. Moreover, newborn boys are three times more likely than girls. But sometimes the anomaly goes unnoticed.

What is a tongue tie?

A frenulum is a mucous film, a ligament located at the root of the tongue, connecting it to the bottom of the mouth. Normally, it is thin, stretchable, does not constrain movements. Anomalies are of two types:

Wrong attachment. The ligament may not begin from the lower third of the tongue, but from its middle or even from the tip. The normal length in a newborn is 8 mm, in a five-year-old child it is about 17 mm. If it is attached incorrectly, the size must be larger, otherwise it limits the mobility of the tongue. He cannot stretch forward, rise to the sky, sometimes practically does not move;
Wrong length. Tongue frenulum too short. Less than 8 mm in a newborn.

What does a normal and short frenulum look like?

If you suspect that your newborn's ligament is not long enough, take a closer look at him, analyze the condition. There are three main ways to determine a short frenulum of the tongue in a child:

A newborn with a normal ligament under the tongue easily protrudes it forward, moves it to the sides. To check, you can touch the bottom lip of the baby with your finger. The child will open his mouth, take out his tongue, move it in search of the breast. If the frenulum is not long enough, the newborn will not be able to stick out his tongue. Slightly raise the tip or, conversely, lower it down;
It is impossible to touch the palate with the tongue with a short frenulum, and with a normal length, the newborn does this without much difficulty. Babies usually carry out a lot of movements with their mouths and tongues. Gaining experience, mastering new sensations. If the child is hungry, the first thing he does is open his mouth, looking for the breast. Therefore, in order to analyze the state of the frenulum of a newborn, you will not have to wait long;
The most obvious sign is the position of the child's tongue during crying. The newborn does this often, because he still does not know how to express his dissatisfaction in other ways. With a normal length of the ligament, the tongue is raised. If it is short in a newborn, the edges of the tongue rise during crying, but the middle cannot. She is held by a ligament.

An accurate diagnosis should be made by a specialist: neonatologist, pediatrician, dentist, orthodontist.

Why is she short?

Experts say that in half the cases, a short frenulum of the tongue in a newborn is a hereditary anomaly. If you or your husband had such a defect, there is a high probability that the children will also have it.

Other reasons for the appearance of a short ligament in a newborn may be:

Negative moments when carrying a child in the first 12 weeks, when all organs and systems are laid: stress, toxicosis, viral diseases, chemical effects (paints, reagents), taking certain medications, such as antibiotics;
Late pregnancy, if the age of the expectant mother is more than 35 years.

It is often impossible to determine the exact cause.

What difficulties does a short frenulum of the tongue create?

The developmental anomaly is the cause of three serious problems in the present and future:

Impossibility of normal breastfeeding. It is explained by the arising difficulties in sucking, swallowing. A newborn spends a lot of time at the breast, while being naughty, he can bite the nipple, and clattering is heard during feeding. He cannot properly lay out his tongue, a short jumper interferes. Read the important article: Proper attachment of the baby to the breast >>>

The baby receives a small amount of “forward” milk, but cannot fully empty the breast. Therefore, it is not stimulated enough. As a result, the child is not gaining weight well (read the current article Weight Gain in Newborns by Month >>>), and milk is getting worse, its volume is decreasing.

You may think that the problem is you. That milk is bad, non-fat, non-nutritious (Related article: How to increase the fat content of breast milk?>>>). And, like most moms, put your newborn on formula. Do not hurry! Breast milk is the ideal food for your baby.

If the mother has experience of feeding, she will understand that the newborn sucks badly, there are no rushes of milk. If the child is the first, it is difficult to draw the correct conclusion. If the newborn is naughty when feeding, loses the breast, cannot suckle for a long time, rarely swallows, consult a doctor, check the frenulum.

Sometimes a baby with a short bridge gains weight well in the first month or two. This is due to postpartum high level maternal hormones responsible for milk production. This is enough for a while even without additional breast stimulation. Soon hormone levels drop, the newborn doesn't get enough food, and weight gain slows down.

At an older age - problems with chewing food;
Incorrect bite, defects in the setting of teeth. The lower incisors turn inward;
pronunciation problems;
Problematic sleep (read about other causes of poor sleep in the article: Why does a newborn sleep poorly?>>>);
Respiratory failure.

How to cut the bridle

Currently, three types of surgical treatment are performed:

Frenulotomy

The most simple operation. At a distance of a third of the length of the bridge, counting from the teeth, an incision is made;
The edges of the mucosa come together and are sutured;
Such an operation is performed on newborns, sometimes even in the hospital. It matters at what age the bridle is cut. The younger the baby, the less constriction of blood vessels and nerve endings.

An operation performed in the first months of life can be performed without anesthesia. Because the child does not feel pain. The frenulum at this age is just a mucous tissue. Only the sight of strangers and the need to be with their mouths open for some time bring discomfort to babies. This type of operation is performed in newborns up to 9 months.

Recovery after the procedure is only a few hours. The newborn is placed on the breast immediately after the operation. You will definitely feel the change in suckling. Both you and your baby will be much more comfortable. Feeding will be effective and complete.

Frenuloectomy (Glikman method)

The essence is the same as in the first method. But first, the bridle is fixed from above with a clamp. The tissues underneath are dissected.

Frenuloplasty (Vinogradova's method)

A triangular flap is cut out of the bridle. Then it is sewn to the surface of the resulting wound;
Before the operation, you need to take tests. Children older than 9 months are shown local anesthesia;
The procedure takes about 10 minutes;
After the operation, you can not eat hot, solid food for several days;
The wound usually heals within a day, it is necessary to strictly observe oral hygiene.

Do I need to trim the bridle and at what age should I do it?

There are different opinions about the correction of ankyloglossia. Whether to cut the child's bridle is up to the parents to decide. If the bridge of the tongue causes problems with breastfeeding, this is a serious indication for surgery.

Other cases where surgical treatment is desirable are:

Displacement of a row of teeth;
Malocclusion;
Defective pronunciation.

The operation is appointed after examination and consultations with the relevant specialists. After the procedure, newborns improve their appetite. In older children, there is a possibility of fusion of the frenulum. Therefore, after the operation, special speech therapy exercises are needed to stretch the ligament. Classes are also needed to correct sounds, since the child is already used to pronouncing them incorrectly.

If your baby is diagnosed with a frenulum under the tongue, do not be too upset. Watch him: how he eats, behaves at the chest, gains weight. Sometimes the shortening is insignificant, and the ligament can stretch on its own.

But if you have weight problems and are considering stopping breastfeeding due to lack of stimulation, you need to make a decision. Correct the situation quickly, painlessly and without consequences, or refuse the operation, stop breastfeeding and face the problem of poor pronunciation in the future

- a shortened hyoid ligament that prevents the full range of movements of the tongue in the oral cavity. A short frenulum of the tongue in a child disrupts the function of sucking, interferes with the formation of correct sound pronunciation, contributes to the displacement of the dentition, the formation of malocclusion, gingivitis, periodontitis, etc. A short frenulum of the tongue in a child is detected by visual examination of the oral cavity. There are two possible ways to treat a short frenulum of the tongue in a child - conservative (stretching the ligament through articulatory gymnastics) and surgical (frenulotomy).

General information

A short frenulum of the tongue in a child (ankyloglossia) is a small congenital anomaly of the maxillofacial region, which consists in shortening the ligament connecting the tongue to the floor of the mouth, and limiting the mobility of the tongue. A short frenulum of the tongue in children occurs with a frequency of 1 case per 1000 newborns; at the same time, ankyloglossia is detected in boys 3 times more often than in girls. A short frenum of the tongue can cause chronic periodontal tissue injury in a child, functional disorders (difficulties in sucking, swallowing, speech formation). The problem of a short frenulum of the tongue in a child is interdisciplinary, affecting pediatrics, pediatric dentistry and speech therapy.

In total, there are three frenulums in the oral cavity: the hyoid frenulum, the frenulum of the upper lip and the frenulum of the lower lip. The frenulum of the tongue is a fold of mucous that extends approximately from the middle of the lower surface of the tongue and is attached to the bottom of the oral cavity at a distance of 0.5-0.8 cm from the neck of the anterior incisors. A normal frenulum of the tongue looks like a thin, tensile cord that does not constrain the movement of the tongue.

In some children, the frenulum is attached closer to the upper third of the tongue or even to its very tip, which can restrict the movement of the tongue to varying degrees, from insufficient activity to almost complete immobility. In a child aged 5 years, the length of the frenulum in the stretched state should be at least 8 mm. If the child's frenulum is shorter, insufficiently elastic, abnormally attached, this condition is regarded as a short frenulum of the tongue.

Causes

In almost half of the cases, a short frenulum of the tongue is inherited by a child from one of the parents. Non-hereditary cases of a shortened hyoid ligament may be associated with harmful effects on the embryo in the first trimester, during the formation of the dentoalveolar system. Among the etiological factors include toxicosis of pregnancy, viral diseases of a woman, taking medications (salicylates, antibiotics, sulfonamides, etc.), stress, exposure to occupational hazards (working with paints, varnishes, chemical reagents), etc. It is believed that minor developmental anomalies are more common occur in children born to mothers over the age of 35.

In general, the reasons for the formation of a short frenulum of the tongue in a child have not been fully studied.

Classification

In clinical practice, there are 5 types of short frenulums that limit the mobility of the tongue in a child:

a thin, transparent short frenulum that limits the mobility of the tongue;
a thin, translucent short frenulum, attached with its front edge close to the tip of the tongue, due to which, when it is lifted up, the tip bifurcates in the form of a “heart”;
a short frenum of the tongue in the form of a thick, powerful, opaque cord attached close to the tip of the tongue. The mobility of the tongue is limited, when extended, its tip turns up, the back rises in a slide;
a short dense strand of the frenulum is fused with the muscles of the tongue. Occurs in children with congenital cleft lip and palate;
the cord of the frenulum is practically not distinguished; its fibers are intertwined with the muscles of the tongue, sharply limiting the mobility of the latter.

Symptoms

Ankyloglossia in children can cause problems with feeding, the formation of speech function, and the development of the dentoalveolar system. The severity of functional disorders in a child with a short frenulum of the tongue depends on the length and elasticity of the ligament, the place of its attachment, the length and flexibility of the free edge of the tongue.

Difficulties with breastfeeding occur in a quarter of children with a short frenulum of the tongue. In this case, the baby cannot properly latch on to the breast, which is why he constantly worsens the latch on the nipple or repeatedly “loses” the breast during feeding. During sucking, characteristic sounds of clicking (clattering) with the tongue appear, restless behavior, and fatigue are noted. At the same time, for one feeding, the child sucks out a volume of milk that is insufficient to saturate. Malnutrition results in poor weight gain and, in some cases, malnutrition.

Often, mothers note that a child with a short frenulum for sucking uses lips, bites or chews the chest with gums, compensating for the incorrect position of the tongue and trying to increase pressure on the chest. With strong tension on the part of the child, due to muscle fatigue, he may experience a jaw tremor.

The process of feeding a child with a short frenulum of the tongue becomes tedious for mother and baby, may be accompanied by pain due to trauma and cracks in the nipple. Inefficient suckling leads to lactation problems (hypogalactia) because it does not stimulate milk production. In this regard, a child with a short frenulum of the tongue is often transferred to bottle feeding or artificial feeding.

In some cases, even with a short frenulum of the tongue, the baby suckles correctly and receives enough milk. In such children, an anatomical feature in the form of ankyloglossia can manifest itself at an older age, during the formation of speech function. A short frenulum of the tongue in a child prevents the correct articulation of sonors ([p], ([p´], [l], [l´]), pinching ([w], [g], [h], [u]) and others sounds of upper articulation ([t], [t "], [d], [d "]). In speech therapy, this condition is regarded as mechanical dyslalia. With a polymorphic violation of sound pronunciation, the child's speech becomes illegible and incomprehensible to others.

A short frenulum of the tongue in a child can cause dental problems: open bite, prognathism, displacement of the dentition, the formation of a diastema between the anterior lower incisors, the development of gingivitis and periodontitis, exposure of the necks and the formation of hyperesthesia of the teeth.

An older child and adolescent with a short tongue frenulum may be bothered by a cosmetic defect (V-shaped tip of the tongue), permanent frenulum tears, profuse salivation during speech, aerophagia, snoring, and sleep apnea. This problem can leave a negative imprint on self-esteem, give rise to emotional and behavioral problems that require the intervention of a child psychologist.

Diagnostics

Various children's specialists can deal with the diagnosis and treatment of the pathology of the frenulum of the tongue and its consequences: neonatologist, pediatrician, pediatric surgeon, pediatric dentist, pediatric orthodontist, pediatric otolaryngologist, speech therapist.

Often a short frenulum of the tongue in a child is found when examining a newborn in the first days of life. At an older age, parents themselves may suspect a shortening of the frenulum of the tongue by the following signs: the child cannot lick his lips, reach his upper teeth with his tongue, stick the tip of his tongue out of his mouth, etc. Medical specialists sometimes use the E. Hazelbaker test to assess the functionality of the lingual frenulum.

Treatment of a short frenulum of the tongue in children

Absolute indications for surgical treatment of a short frenulum of the tongue are problems with feeding a child, displacement of the dentition and the formation of malocclusion. Violation of sound pronunciation in 90% of cases can be corrected by stretching the hyoid ligament as part of speech therapy classes to correct dyslalia using special exercises of articulatory gymnastics (“Horse”, “Fungus”, “Delicious jam”, “Malyar”, “Accordion”, etc. ), speech therapy massage. In case of malocclusion in a child caused by a short frenulum of the tongue, orthopedic treatment is indicated.

If a short frenulum interferes with normal feeding, it can be cut to the child while he is still in the hospital. The operation of dissecting the frenulum (frenulotomy) at this age is completely painless and is performed without the use of anesthesia, since the frenulum itself does not contain nerve endings. To stop the bleeding, the child is immediately applied to the mother's chest. In children under the age of 9 months, the dissection of the short frenulum of the tongue is performed using scissors (electric scalpel, laser scalpel) under local application anesthesia.

At an older age, when the frenulum becomes thicker, plastic frenulum of the tongue (frenuloplasty) may be required - dissection of the frenulum and transfer of its attachment site with suturing. After surgical correction of a short frenulum of the tongue, a child (preschooler, schoolchild) needs speech classes with a speech therapist to overcome stereotypical speech habits and form correct speech skills; myogymnastics - to avoid scarring.

Forecast

The prognosis for the treatment of a short frenulum of the tongue in a child is good in most cases. The dissection of the frenulum of a newborn is accompanied by an improvement in sucking, swallowing, breathing, and an adequate increase in body weight. Early dissection of the short frenulum of the tongue in a child avoids problems with the development of the baby, the formation of bite, speech.

It should be understood that plastic surgery of a short frenulum of the tongue, performed on an older child, cannot automatically lead to the normalization of speech. To correct defects in sound pronunciation, a course of special speech therapy classes. A conservative tactic for stretching the short frenulum of the tongue in a child requires patience, the systematic implementation of the recommended exercises. This method is most effective in children under 5 years of age.

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, men with diabetes mellitus against the background of circulatory disorders suffer from recurrent balanoposthitis, in which the foreskin and skin of the head of the penis become inflamed. It also causes the 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 more intense the 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 case of 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, no special preparation is 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:

When taking a shower, put a condom on the penis so as not to wet the wound.
Do not have sex until the wound is completely healed.
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.

A serious consequence is bleeding and sharp pain from the rupture of the frenulum. In this case, it is important to immediately stop the blood - press the head for 10 minutes, then take a bath with a 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.

In medicine, a frenulum is a small piece of connective tissue that is located in the mouth. There are 3 frenulums: tongue, lower and upper lip. They serve as a guarantee of the correct functioning of the speech apparatus, the desired speed and direction of its movement.

In all people, the bridles have their own length, density and elasticity, plus, they are attached in different ways. These factors affect the clarity of pronunciation of sounds, the clarity of speech and the normal intake of food. A very short frenulum of the tongue in a child leads to limited movement of the tongue, which subsequently causes problems with speech development.

Symptoms of a short frenulum of the upper lip and tongue

A short frenulum of the tongue in a newborn is detected immediately after the birth of a toddler and it is cut if necessary. Not only a pediatrician or dentist can determine the presence of this defect. Parents can figure it out on their own characteristics. Symptoms that indicate a problem include:

A peculiar form of language. It becomes heart-shaped, and its tip is slightly pulled back.
Breastfeeding problems. The newborn does not grasp the nipple correctly, as a result of which he is not able to hold the breast for a long time, and the process lasts for a long time.
Poor weight gain. It is the result of malnutrition.
Regurgitation and colic after application to the breast. Also, the newborn may swell the stomach.
Changed appearance of the mother's nipples. Cracks appear on them.

As for the short frenulum of the upper lip, before the central incisors erupt in the child, this defect does not cause noticeable difficulties. However, after eruption, there is a risk that it will fall into the gingival papilla between the teeth. As a result, a gap is formed, called the true diastema. In addition to her, they say about the problem:

Reasons for the formation of a short frenulum

The most common reason for the formation of a short frenulum of the tongue is heredity. If one of the parents was or is the owner of a short lingual strand, then the likelihood of a shortened hyoid frenulum in a child increases greatly. In addition to heredity, the development of pathology is affected by:

The course of pregnancy. If during the period of gestation a woman had early toxicosis, or she took hormonal drugs and antibiotics, then the risk of forming a short tongue in a child is high.
Abdominal trauma during pregnancy.
Age indicators. More often, pathology occurs in children who were born after 35.
Infectious diseases during the period of carrying the fetus.
Bad ecology.

Varieties of a shortened bridle

The pathology of a shortened frenulum is classified into five main varieties:

The jumper is transparent and thin. It practically does not restrain the movement of the tongue.
The cord is thin and translucent. In such a situation, when the tongue is lifted, its tip is bifurcated and it acquires the shape of a heart.
Opaque thick bridle. The protruding tongue has a tucked tip and a raised back.
A short cord that fuses with the muscles of the tongue.
Almost complete absence of a jumper. It is tightly fused with the tongue muscles.

Problem Diagnosis

After childbirth, the neonatologist necessarily conducts a visual examination of the oral cavity of the newborn. The normal length of the bridge at this age is 8 mm. The doctor needs to retract the lower lip a little so that the child opens his mouth, and he can diagnose the problem of a short hyoid band.

In older children, a local pediatrician, therapist or speech therapist can establish the diagnosis of a short tongue. At 2-3 years old, babies begin to talk, and the presence of speech problems indicates a possible defect. In the future, the child is sent for examination to the dentist or orthodontist.

It is possible to diagnose a defect in the short frenulum of the lip or under the speech organ on your own, referring to the forums, the website of the school of Dr. Komarovsky. Photos from the Internet will also help, which show how the hyoid bridge and bands of the upper and lower lips look like in normal and abnormal development.

An adult is able to conduct a simple test. To do this, stick out the tongue as far as possible. If it does not bend down at a distance of two centimeters, then there is no pathology with a frenulum. It is important not to ignore the problem and consult with a specialist to determine the appropriate treatment.

How to fix the situation?

The presence of such a pathology in a child as a short jumper under the tongue, upper or lower lip does not necessarily require surgery. The specialist should decide which method of correcting the defect.

There are two main ways to solve the problem:

Orthopedic. It includes speech therapy gymnastics and a number of exercises aimed at stretching the frenulum.
Surgical. The meaning of the operation is to cut the cord with sterile scissors.

stretching

If a short bridle does not prevent a baby from fully breastfeeding, then the operation can be postponed. For older children, a speech therapist can help correct the defect. Stretching the shortened strand and giving it elasticity is carried out by two methods:

special articulation gymnastics;
logopedic massage.

Part of the exercises that are included in the gymnastic complex, parents can perform with their children at home. Among them:

The positive effect of stretching is possible only in the case of regular exercise every day. They can be carried out several times a day, gradually increasing the duration and complexity.

As for speech therapy massage, such a procedure is quite painful and unpleasant. As a result, the children do not like her very much.

pruning

Not in all cases it is possible to do without surgical intervention. Sometimes only speech therapy exercises may not be enough to overcome the problem. Scissors or a laser are used to cut the frenulum (see also: how is the frenulum cut in children done under the tongue?). There are three ways to perform the procedure:

The ideal time for surgery to correct a short tongue defect is considered to be the first weeks after the birth of a child. During this period, the bridge is still thin and has no nerve endings, so the operation is painless and does not require anesthesia and suturing.

If the baby was not cut the bridle in the hospital, then it is better to postpone such a procedure until the age of 2.5 years. At this time, the milk bite is already fixed, but the formation of pronunciation has not yet been completed.

Another favorable period in which you can trim a short strand is 5 years. Milk teeth are replaced by permanent molars, the bite is formed.

Modern technologies make it possible to carry out operations of this kind at any age. Usually they do not last long and do not lead to serious complications. However, already adult children after them need additional therapy of a speech therapy nature.

Possible complications after the intervention

Usually the cord is cut in the hospital. Indications for surgery are problems with feeding the child. Otherwise, it is not required. The procedure is quick, without causing pain to the baby. After the baby, it should be applied to the chest so that the wound is washed with breast milk. This prevents infection from getting into it.

The operation in adolescents and adults already requires the use of anesthesia and suturing the wound, as the frenulum becomes denser, it already has blood vessels and nerve endings. The older the patient, the longer it takes for the wound to heal. The main complication after surgery is pain. Pain medications, such as Ibuprofen, Paracetamol, or other pain relievers (children are allowed) will help to cope with it.

Another possible complication is the formation of a postoperative scar. In this case, repeated surgery is required.