Jason Erasmus - Oral and Maxillofacial Surgeon, Christchurch, New Zealand

Frenectomy

A frenectomy is the surgical release of a frenum. The frenum is the tag of "skin" between the lip and gum (labial frenum) and below the tongue (lingual frenum).

Labial Frenum

This tag of tissue occasionally attaches too high up on the gum. The upper or lower lip might be affected but more commonly the upper lip is involved. In severe cases the attachment is thick and fibrous resulting in a diastema (spacing) between the two front teeth. Often patients have consulted a dentist or an orthodontist to close this gap. The labial frenum might be a problem in patients of all age groups from toddlers to adults.

The treatment involves a minor surgical procedure. In older children and adults the frenectomy can be performed under local anaesthesia with or without intravenous sedation. However in very young children it is best performed under general anaesthesia.
The timing of the surgery is controversial. Some surgeons feel the frenectomy should be performed prior to orthodontic treatment to close the gap, where as others believe orthodontic treatment should be commenced first.

Lingual Frenectomy

Occasionally the lingual frenum is attached too far forward on the tongue. This results in restricted movement of the tongue. The patient often cannot protrude the tongue and there might be "notching of the tip of the tongue" on protrusion. This is commonly referred to as a "tongue tie".

The "tongue tie" is seen in patients of all ages from infants to adults. In infants a "tongue tie" can lead to feeding difficulties, and in preschool children it might interfere with speech. Adolescents and adults might find that the "tongue tie" affects them socially.

Treatment is the surgical release of the "tongue tie" (lingual frenectomy). In infants and preschool children, if the "tongue tie" is interfering with feeding or speech, the frenectomy should be performed at that time, and it is best performed under general anaesthesia.

In older children and adults, the need for surgical release is determined by the degree of limitation to the patient. In this group of patients the frenectomy can be performed under local anaesthesia.

There is a theoretical possibility of the frenum reattaching to its original site but this is uncommon. The frenectomy is a relatively minor procedure and patients generally do not complain of significant post operative discomfort.