Plastic surgery of the frenulum of the upper lip: indications, description of the operation

May 31, 2020

Under the upper lip, right in the center of each person, there is a ligament that connects the lip to the alveolar part of the jaw and is called the frenulum. For some, this ligament is short and attached too low, which creates certain difficulties and health problems, which we will definitely talk about below. In this regard, doctors suggest that such patients undergo plastic surgery of the upper frenulum. And UltraSmile.ru journalists will tell you about the operation and its indications in detail.

There are many indications for frenuloplasty

Few people know that the upper frenulum is very important for the correct and full functionality of the dental system. Thanks also to her, we can move our lips, pronounce different sounds, and open our mouths. It also plays an important role in the formation of a beautiful smile aesthetics. If it is shortened or positioned incorrectly, then in some cases this creates conditions for the development of various anomalies and leads to serious problems and consequences, which, in fact, are indications for trimming the frenulum of the upper lip in adults and children.

At what age is it best to have surgery?

Trimming the frenulum of the upper lip is a relatively easy operation, but the optimal age for it, according to most doctors, is 5–7 years, when the permanent incisors begin to emerge. If you carry out the procedure during this period, you can avoid the formation of a diastema and further manipulations to correct the bite by the orthodontist. But according to indications, it is not too late to perform plastic surgery in adolescence, and even in adults.

“I took my child to this operation. My son was 8 years old at the time. He already understood everything that was said to him, and at the same time he was very afraid. Before the operation, we sat and calmed down in the doctor’s office for about 15 minutes. I want to say that the child’s psychological attitude is very important here. About the operation itself: it didn’t hurt, my son didn’t cry. But after the anesthesia began to wear off, he complained that his gums hurt, but this problem was solved with Nurofen syrup. Already on days 4–5, the trace of the wound was almost invisible, although it was done with a scalpel. But in children everything heals quickly.”

Lada, review from the dental portal gidpozubam.ru

The operation is best performed at the age of 5-7 years

Indications

Medical intervention of any type must certainly be justified. A simple statement of the fact of the presence of a shortened frenulum is not an indication for emergency surgery. Plastic surgery to correct the frenulum is performed in the following cases:

Diastema between the central incisors

If there is a diastema (gap) between the central incisors. The frenulum of the upper lip, woven into the interdental papilla and forming a thick cord, prevents the incisors from converging towards the center. In addition, exposure to a small constant load leads to a gradual increase in the diastema and displacement of the teeth forward and to the sides from the center, as well as the development of periodontitis due to constant injury to the interdental papilla.
In preparation for orthodontic therapy. Soft tissue cords located in the oral cavity, including the frenulum of the upper lip, exert a certain load on the dentition and influence the formation of the bite. If bite correction procedures are prescribed (installation of plates or braces), you also need to pay attention to the correct attachment of the upper lip frenulum.
If you have periodontal diseases and are at increased risk of their occurrence. In these cases, the short frenulum seems to “pull” the mucous membrane from the base of the teeth, which leads to gum recession - raising its edge and exposing the roots of the teeth.
In preparation for removable prosthetics. If the installation of dentures is planned, then it is first necessary to perform plastic surgery of the frenulum of the upper lip, since a shortened frenulum will provoke the shedding of the dentures.
In case of impaired sound production and other speech therapy problems (as a rule, this indication is less common than others).

Types and technologies of upper frenuloplasty

Before the procedure, it is important to carry out a complete sanitation of the oral cavity, treat diseased teeth and stop acute inflammatory processes, remove bacterial plaque - all these are sources of infection, which can subsequently provoke postoperative complications. You should also eat before surgery, as hunger can impair blood clotting.

There are several techniques for performing the procedure. The doctor decides which one to use depending on the patient’s age, the location and attachment of the frenulum. Let's list all the technologies that exist today:

frenotomy, or frenulotomy: involves transverse dissection of the frenulum if it is very narrow and thin. This is the so-called minor operation, which is considered the least traumatic. The purpose of the manipulation is to relieve the tension of the ligament. The procedure can be performed on newborns, as well as older children,
frenectotomy: this is a more complex operation, during which the frenulum of the upper lip is trimmed and part of the tissue located in the space between the central incisors is removed. The procedure is performed if the frenulum is thick, as is often the case in adolescent and adult patients,
frenuloplasty: the doctor releases the ligament and moves it to the area where it should be.

The operation is performed under local anesthesia.
Each of the listed operations is performed on an outpatient basis, under local anesthesia. Traditionally - using a scalpel. Afterwards, the doctor applies self-absorbing sutures and sends the patient home. Everything lasts about 10–15 minutes. Next, the patient receives clear recommendations on how to behave during the rehabilitation period. 1 and 3 days after the operation, you need to visit the doctor again for follow-up examinations.

Today, plastic surgery of the upper frenulum can be performed using a laser, which allows the procedure to be carried out quickly, without pain and blood, and to disinfect the operated tissues. This also reduces the likelihood of developing postoperative complications (swelling, pain, inflammation, scars). A big advantage is that when using laser equipment there is no need to apply stitches.

Laser frenulum trimming is the least traumatic

The rehabilitation period takes about 10–14 days. During this time, the patient is not recommended to eat food that can irritate the operated tissues (cold, spicy, hot, hard). It is also necessary to rinse your mouth with an antiseptic and apply wound-healing ointments (for example, Solcoseryl).

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prevention

Alimirzoev F.A. Dental anomalies in childhood and their diagnosis // Achievements of university science. – 2014.

Consulting specialist

Geraskina Inna Igorevna

Doctor rating: 9 out of 10 (2) Specialization: Dentist-therapist, orthodontist Experience: 10 years

Laser plastic surgery

Laser removal of the upper lip frenulum is becoming increasingly popular. The operation site is treated with an anesthetic gel, then a laser light guide is directed to the frenulum, forming a beam of light that “dissolves” the frenulum. At the same time, the laser disinfects and seals the edges of the wound.

Advantages of laser plastic surgery:

absence of vibrations and various sounds that can frighten a child;
bloodlessness;
no need for stitches;
there is no risk of infection;
absence of pain and postoperative scars;
reducing the duration of plastic surgery;
fast rehabilitation.

The cost of the procedure varies from 3 to 5 thousand rubles.

Familiar firsthand

My son had problems with diction. The speech therapist said that this was due to a short frenulum of the upper lip and advised it to be corrected.

After the operation, the child began to pronounce sounds more clearly. During the procedure itself I did not feel any pain, and after the operation there was no stitch left.

Valentina Semyonovna, 36

Comments

Which doctor can give a referral for this operation?

Marina (06/14/2020 at 07:28 pm) Reply to comment

Editorial staff of the portal UltraSmile.ru (06/17/2020 at 09:07) Reply to comment

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What is upper lip frenuloplasty?

Surgical correction of a connective cord defect is an effective surgical technique that allows you to correct your bite, eliminate problems with diction and prevent the development of dental pathologies. The intervention is carried out under local anesthesia by dissecting the fold tissues and then attaching them to the desired location.

According to official statistics, approximately every sixth child under the age of 6 years undergoes frenuloplasty. Also, children are often offered correction of the lower cord, located below between the skin-muscular fold surrounding the mouth and the mucous membrane of its cavity in the middle of the central incisors.

Types of surgical operations

Normally, the frenulum of the upper lip looks like a thin fold located exactly along the midline of the dentition with the junction with the gum 5-8 mm above the gum line of the front teeth.

If it is fixed too low or is located between the central incisors, it is said to be a pathologically short frenulum of the upper lip (PLF).

Depending on the form of the pathology, there are 3 types of surgical operations to correct it:

Frenotomy. The simplest case. The frenulum looks like a thin transparent film; there is no connection with the alveolar process. The frenulum is dissected with a transverse incision, usually in the shape of the letter “V”, and longitudinal sutures are applied.
Frenectomy. The frenulum is of considerable width and extends to the interdental papilla. An incision is made along its ridge, including the area between the central incisors, tissue is removed several mm deep, and sutures are applied.
Frenuloplasty. The most large-scale operation. It is used when it is necessary to move tissue and the place where the frenulum is attached. It is performed using several methods, which will be discussed below.

Terminological information. The words “freno” or “frenulo” come from the Greek. "Phren" or "Phrenes", meaning diaphragm, partition. “Tomia” means opening, dissection, “ectomy” means removal, excision.

Adults can seek frenulum correction solely to improve the aesthetics of their smile.

How a dental cyst is removed using cystotomy and how the operation is performed.

Come here if you are interested in how dental cystectomy is performed.

At this address https://www.vash-dentist.ru/hirurgiya/rezektsiya/povodom-k-periostotomii.html we will talk about what can become a reason for periosototomy in dentistry.

Consequences of refusing treatment

The main negative effect of a short frenulum is to pull up the area of the gum located between the central incisors. If it is not eliminated, the following negative consequences are possible:

disruption of the baby’s sucking process and, as a result, lack of nutrients from mother’s milk, weight loss, and feeding for the mother can become painful;
persistent speech impairment;
diastema formation;

deterioration in chewing food during complementary feeding;
deterioration of oral hygiene due to food debris getting stuck in the folds of the frenulum;
the formation of gum pockets with all their negative consequences: accumulation of food debris, deposition of tartar on the neck of the tooth and root, inflammation of the gums, penetration of infection into the periodontium;
exposure of tooth roots, sensitivity to hot and cold;
unsteadiness of the maxillary central incisors;
malocclusion;
deterioration of smile aesthetics;
obstacle to orthodontic or orthopedic treatment.

Thus, surgical intervention for a short frenulum of the upper lip is necessary for periodontal, orthodontic, cosmetic and orthopedic indications.

From the video, learn about the benefits of using a laser according to patients.

Stages of implementation

The first stage, as in other types of surgical intervention, includes consultation with a specialist. When examining the baby, the doctor:

determines the form of the pathology (assesses the width of the fold, the location and features of its attachment, the anatomy of the upper lip);
establishes the absence of contraindications - refers to fluorography and blood tests, mainly to determine its coagulability;
selects the operation protocol and assigns its time;
informs parents that before the operation it is necessary to feed the child for calmness and better blood clotting.

Most likely, you will need to visit the dentist for oral sanitation.

Frenuloplasty is performed under general anesthesia using two methods:

Y-shaped;
Z-shaped (according to Limberg).

With Y-shaped frenuloplasty, the frenulum tissue is cut out with a scalpel or scissors. In the resulting diamond-shaped incision, the edges of the mucosa are trimmed, advanced into the vestibule to eliminate tissue tension, and sutured to the periosteum.

Z-shaped plastic is performed as follows. A longitudinal incision is made in the center of the frenulum, from the edge of which two oblique lines extend , so that the incision takes the shape of the letter “Z”. Triangular flaps are advanced into the vestibule and attached with sutures to the periosteum.

Clevical frenuloplasty lasts about 20-30 minutes. If a diastema has already formed, it can disappear by itself under the pressure of the lateral incisors. If this does not happen, orthodontic treatment is carried out to eliminate it.

Indications and restrictions

Correction is indicated in all cases where the anomaly limits the functionality of the dentofacial apparatus at present or creates a risk of developing pathologies in the future. A negative impact on facial aesthetics is also a sufficient reason to contact a dental surgeon.

The following factors may serve as specific indications for frenuloplasty:

Formation of gum pockets under the influence of pulling back the edge of the gum by the frenulum.

Periodontal diseases, the root cause of which is a short frenulum. Accumulation of food under the frenulum or in the gingival pocket, resulting in inflammation of the gums, penetration of infections into the periodontal sulcus and further into the periodontium.
Problems with sucking in infants.
Upcoming treatment with orthodontic appliances or dentures. If the denture or orthodontic removable device is located in the anterior part of the dental arch, it can be reset by a short frenulum.
Problems with chewing and swallowing. Unpleasant tension in the upper lip area may force the child to swallow large, unchewed pieces;
Diastemas.
Danger of developing malocclusion due to tension on the frenulum.
Speech impairment for the same reason.

Contraindications to correction are standard cases in which any operations are contraindicated:

Blood clotting disorder.

Acute inflammation and infectious processes in the RP;

Osteomyelitis of the jaws.
Severe forms of caries.
Oncological diseases and accompanying radiation, etc.

Cost of upper lip frenuloplasty

The price of the procedure is quite affordable for patients with different income levels. It can hardly be called budgetary, but it is not one of the expensive manipulations either. Laser plastic surgery of the labial frenulum requires the largest financial investment. This is the most modern method, so special equipment is required to implement it. The average cost of plastic correction of a lintel is approximately 20-60 USD. e.

Who prescribes the procedure?

If you notice a short pathology, contact the following specialists: neonatologist, orthodontist, speech therapist, periodontist. The dentist or surgeon does not provide objective guidelines for surgery.

The neonatologist has the right to prescribe intervention if the defect interferes with normal breastfeeding. As a rule, we are talking about pathology of the structure of the upper lip, since it is actively involved in the sucking procedure. In some cases, this specialist may independently perform the removal of the bridge or write a referral to a pediatric surgeon.
The speech therapist determines the anomaly when speech dysfunction and hypoplasia of the speech organs are visualized. Often, pathology is detected when a child pronounces the vowels “o, u” and others that involve the lips in the pronunciation unclearly or incorrectly. The speech therapist, unfortunately, visualizes the pathology later. In this case, ordinary pruning will not correct the situation; you will need to resort to surgical intervention.
Often the need to perform surgical intervention regarding the frenulum is determined by an orthopedist, orthodontist and periodontist.