Cutting Vs. Stretching: Choosing The Right Procedure For A Short Frenulum

A short lingual frenulum, also known as being "tongue-tied," can cause problems with oral health, speech and language, and even one's ability to swallow. In some babies and children, the shortness of the frenulum is such that the babies and children cannot even lift their tongues from the bottoms of their mouths. There are two procedures that can help with this issue.

Cutting the Tongue-Tie: Frenotomy

Cutting the tongue-tie, or frenotomy, is the most common procedure. It is often done under localized anesthesia, unless the baby or child is going to be too mobile for the procedure to be safe. General anesthesia is reserved for frenotomies that are more complicated or for children who will absolutely not sit still and keep their mouths open long enough for the doctor to complete the procedure. If the tongue-tie is too short and too thick, it may need a more complicated procedure under general anesthesia.

"Stretching" the Tongue-Tie: Frenoplasty

While the suffix of -plasty might make you think of cosmetic procedures, a frenoplasty is anything but. In this procedure, your child is anesthetized completely. Then the surgeon goes about lifting the tongue as high as he/she can before using a scalpel to cut the tongue-tie from the tip of the tongue to the center-most point of the underside of the tongue. The frenulum is typically more membrane than flesh, but tongue-ties of this type are often mostly flesh—thus, the more invasive and complicated surgery.

If the surgeon wants to give your child an actual frenulum (which is preferable if your child has not yet learned to speak and will need a lot of speech therapy), the surgeon will construct a frenulum. It may be an artificial frenulum constructed from cosmetic membranes and surgical mesh, giving it a "stretched" appearance. Natural tissues may grow over the cosmetic membranes and/or mesh.

It may also be constructed from slices of the thick frenulum that was removed during this procedure. The tissues are your child's own, which means there will be less of a chance of rejection of the reconstructed frenulum. Additionally, it means faster healing because the cells in the blood and tissues of the new frenulum belong to your child.

Discussing the Procedures with Your Child's Doctor

The risks for either of these procedures are essentially the same. The main differences have to do with the severity of your child's tongue-tie, the need to reconstruct a frenulum, and/or your child's ability to hold still during a procedure (most babies and children are not able, although that depends on the child). Discussing the procedures with your child's doctor or specialist will help you make a better decision about which one to do and when to do it. 

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