Exodontia.Info
Frænectomy / Tongue-Tie Release
Explanation & Warnings
A frænum is a band of fibrous tissue that links the lips
to the gums or the tongue to the gums.

Upper Jaw Frænum.

A ‘high’ or prominent upper
frænum in children, although a
common finding, is often a concern, especially when
associated with a
diastema (a space between 2 teeth such
as the upper central incisors).  Treatment is necessary
only when the
frænum exerts a traumatic force on the gum
or it causes a
diastema to remain open after eruption of
the permanent canines / ’eye’ teeth.

In an older child, if a
frænum is present and the tissue
immediately behind the central incisors on the roof of the
mouth side of the teeth blanches when the upper lip is
pulled, removal of the
frænum is indicated.
















Early treatment is also indicated to prevent subsequent
inflammation, recession of the gum around the spaced
teeth, pocket formation within the gums and the possible
loss of the bone supporting the teeth and/or teeth
themselves.

Tongue Tie / Ankyloglossia.

A
Tongue Tie / Ankyloglossia is characterised by a short,
thick fibrous band linking the tongue to the gum just behind
the
lower central incisors.  It limits the movement of the
tongue.
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Clinical situations in which a (upper) labial frænectomy is performed include:

  • A hypertrophic thick fleshy frænum
  • A positive ‘blanch test’ of the incisal papilla when pulling the lip forwards
  • A large midline maxillary suture present radiographically
  • To facilitate orthodontic treatment for closure of a diastema
  • To enhance the chances of the diastema remaining closed after orthodontic
  • treatment
  • A persistent midline diastema
  • To eliminate undesirable tension on the gingival papilla or gingival margin
  • To facilitate lip lengthening procedure
  • To allow effective toothbrushing in the area of the frænum


This list of warnings might seem excessive to some however the legal ruling in
the case of Chester vs Afshar (2004) would suggest that it is quite prudent /
necessary to list them.  Others might say that there isn't enough information but
where do you stop?

The following list of warnings regarding frænectomies is neither exhaustive nor
is it predictive.  The most pertinent warnings have been included here.


Pain.  As it is a surgical procedure, there will be soreness after the frænum has
been removed.  This can last for several days.  Painkillers such as Ibuprofen or
Paracetamol are very effective.  Obviously, the painkiller you use is dependent on
your medical history & the ease with which the
frænectomy was carried out.

Swelling.  There will be swelling afterwards.  This can last several days.  
Avoidance in the first few hours post-op of exercise or hot foods / drinks will
decrease the degree of swelling that can develop.

Stitches.  The frænectomy site will be closed with stitches.  These are dissolvable
and ‘fall out’ within 10 – 14 days.

Limited Mouth Opening.  Often the chewing muscles and the jaw joints are sore
after the procedure so that mouth opening can be limited for the next few days.

Conscious Use of Tongue.  Don’t automatically assume that once the tongue tie
has been released, you’ll be automatically able to stick your tongue out.  You will
have been used to the tongue being limited in its movements for a number of years
so to fully use the ‘released’ tongue, a conscious effort will have to be made to
use it.

Floor of the Mouth Complications.  This may have an effect on the salivary ducts
in the region of the floor of the mouth in that the stitches may restrict the outward
flow of saliva and this can lead to ballooning up of the floor of the mouth.  If this is
the case, get back in contact with the OMFS department / Oral Surgeon post-
haste.

Repetition of Frænectomy.  Sometimes, the degree of tongue movement is not as
great as expected and may mean that the
frænectomy needs to be done again.  
Post-op tongue-tie release exercises are advocated by some peopletongue tie

Closure of Spaced Teeth.  Having an upper frænectomy will not necessarily by
itself, produce the closure of the space.  It is often an adjunct to the Orthodontic
closing of the space.

Exposed, Raw Areas.  If the upper frænum has been removed, there may be
initially, an area in the midline where the gums can not be approximated; this
produces a raw area that can take awhile to heal.

Gum Recession.  When the upper frænum is removed, it is possible that the
gums around the upper central incisors may recede.

Level of ‘Lip Line’.  Once the frænum has been removed, the upper lip is freed
and can ‘ride up’ higher displaying more teeth and gums (that is, showing a higher
lip line).


Useful Articles:

Dental Update 2011.  Maxillary Labial Fraenectomy - Indications & Techniques

J Clin Diag Res 2012.  Frenectomy.  A Review with the Reports of Surgical
Techniques

Dentistry 2013.  Comparitive Results of Frenectomy by 3 Surgical Techniques -  
Conventional, Unilateral Displaced Pedicle Flap & Bilateral Displaced Pedicle Flap


Useful Website:

Wikipedia
The significance and management of ankyloglossia are controversial.  Studies
have shown a difference in treatment recommendations between
Speech
Therapists
, Pædiatricians, Ear, Nose & Throat Surgeons and Oral & Maxillofacial
Surgeons
.  Most professionals, however, will agree that there are certain
indications for
frænectomy.

A
tongue tie can limit tongue movement and create swallowing problems.  A
frænectomy for functional problems should be considered on an individual basis.

A
tongue tie can lead to problems with breastfeeding, speech, how teeth bite
together and potential gum disease and gum recession problems.  The
frænectomy will only be done if evaluation shows that function will be improved by
surgery.
Photos of Ankyloglossia / Tongue Ties
Ankyloglossia can be classified into 4 classes based on Kotlow's Classification
as follows:

  • Class I: Mild ankyloglossia (12 - 16 mm)
  • Class II: Moderate ankyloglossia (8 - 12 mm)
  • Class III: Severe ankyloglossia (3 - 8 mm)
  • Class IV: Complete ankyloglossia (< 4 mm)

Class III and IV tongue-tie categories should be given special consideration
because they severely restrict the tongue's movement.
A normal range of motion of the tongue is indicated by the following criteria:

  • the tip of the tongue should be able to protrude outside the mouth without
    'clefting'
  • the tip of the tongue should be able to sweep the upper & lower lips easily
    without straining
  • when the tongue is retruded, it should not blanch the tissues lingual to the
    anterior teeth &
  • the lingual frænum should not create a diastema between the mandibular
    (lower jaw) central incisors.
Last Updated 25th August 2015