How to check if the bridle is short. The case for dentists

They can show up even in the hospital at the first examination by the pediatrician, or it can become an unpleasant discovery for parents, whose child at the age of three or four years does not learn to pronounce a number of letters. Be that as it may, and in fact, and in another case, it will most likely go about the short frenum of the tongue. We will talk about what this diagnosis means, where it comes from and how to treat it, in our article.

What is the pathology and how often does it occur in newborns

A short bridle is called, which prevents the free movement of the tongue in the oral cavity. This can be caused either by its insufficient length or by improper placement, for example, when the bridle begins at the very tip of the tongue. Almost half of all are born with such a problem, but not everyone is indicated by doctors at birth, and for many, the situation itself improves and fades away in the process of the baby's growth.

Why is the short frenum of the tongue dangerous?

The danger of this for babies is that the short sublingual ligament can prevent the baby from properly applying to the nipple and sucking on the breast.

These babies often cannot be fully breastfed because they are unable to suck out enough milk on their own to grow and develop normally. For older children, deformation of the bridle is fraught with incorrect pronunciation of letters and incorrect development of speech.

If, after opening his mouth, the child cannot reach the upper teeth with his tongue, he is most likely to have problems with the pronunciation of certain sounds.

Why is this happening

Divide the congenital and hereditary forms of this. If a mom or dad had problems with a bridle in infancy, then there is a high probability that their child will be "rewarded" with the same problem. As for the congenital form of the disease, then this can be influenced by several factors:

• various viral, which the mother could be sick in the process;
• infections of the baby in the womb;
• trauma to the tummy during gestation;
• the age of the expectant mother has crossed the line of 35 years;
• mom's unhealthy lifestyle, alcohol consumption;
• bad ecology;
• taking hormonal drugs during 1-3 trimesters;
• stress;

All these negative factors significantly increase the chances of giving birth to a baby with a short frenum of the tongue.

Main signs and symptoms

So, let's look at how to define a short bridle y. To do this, you should pay attention to how the baby sucks at the breast. If the baby copes well with this matter, the process does not cause any trouble for him and his mother - there is nothing to worry about.

If, even a few days after birth, when the baby is just learning to eat, the feeding process still does not get better: the baby takes the nipple incorrectly, cries, gets nervous, smacks loudly while sucking, and milk is poured out of the mouth - this is a reason to worry and consult a doctor. because most likely the baby has problems with the bridle.

This is what concerns babies. Now let's look at the question of how to understand that a child at the age of 3-4 years has a short bridle. Mispronunciation may be a reason to draw attention to this.

By the age of 4, boys and girls for the most part already know how to pronounce all the letters correctly. If not in words, then at least separately.
When this age has problems with the pronunciation of sounds such as "w", "w", "u", "h", "z", "l" and, parents should show the baby to a specialist and consult on the subject of a short frenum of the tongue.

Diagnostics

In order to diagnose this pathology, the doctor may ask the child to do the following exercises with the tongue: reach it with the tip to the upper row of teeth, palate, touch the tip of the tongue alternately with the corners of the mouth, try to reach the nose, chin, lick your lips, roll it into a tube.

Did you know? In modern medicine, there is such a technique as laser dissection of the sublingual cord. Its plus is that after it you do not need to put stitches, and this significantly speeds up the healing process.

If these techniques are obtained with ease by the baby, then there is no reason to worry. If they cause difficulties for the crumbs, a speech therapist or an experienced therapist can diagnose ankyloglossia and decide whether to cut the frenum of the child's tongue.
The mother herself can detect the problem by examining the oral cavity of her child. If the baby's sublingual ligament is visually shorter than 8 mm, if it starts from the very edge of the tongue, when its tip has a bifurcated shape, and when crying, the shape of this organ resembles a boat, you need to show the child to the doctor in order to confirm or dispel suspicions about "problems" with the frenum.

Important! It is necessary to diagnose pathology and start treatment as early as possible. Prolonged ankyloglossia can lead to problems such as periodontitis, gingivitis, and crooked teeth.

Do I need to cut and why should a child do it

Now let's look at the reasons for the surgical intervention and what kind of doctor cuts the frenum of the child's tongue. The neonatologist decides whether to undercut the sublingual ligament in newborns.

The reason for making such a decision may be the inability of the baby to eat and, as a result, grow and develop. As a rule, at this age, frenulotomy is performed without anesthesia.

Such a procedure is not a complicated operation, and within a few hours after the frenum of the tongue is cut, the child does not have any painful sensations.
As for older children, a speech therapist can prescribe a referral for surgery. The decision on the need for it is made by the dentist.

When a child develops an irregular bite, if his teeth grow "out of order", or there is a need to place a dental implant, when gymnastics to stretch the frenum does not solve the problem with incorrect pronunciation of sounds, the doctor decides to cut it.

What is the best age for the operation

Many parents of young children are concerned about the question: when it is necessary to cut the frenum of the child's tongue, so as not to frighten or harm him. Frenulotomy is best done during the first month of a baby's life.

This is due to the fact that the tissues and nerve endings in the baby's oral cavity are not yet fully formed, and the operation during this period will not cause pain to the child. Plus the fact that the procedure will be performed at an unconscious age will protect the little one from stress.

If the pathology was not detected on time and began to manifest itself in the form of speech defects in the grown-up child, then the question of pruning should not be postponed indefinitely, since after five years the child will get used to distorting sounds, and even if the operation is successful, there is no guarantee. that speech will be corrected.

Correction and treatment of pathology

However, the manipulation of cutting the bridle is still an extreme measure. Before prescribing an operation, doctors, as a rule, refer the child to a speech therapist for a course of special massage and aimed at stretching the sublingual cord.

This course includes articulation exercises, verse repetition and tongue twisters.

The following are exercises that can help your toddler stretch the frenum while exercising at home with you:

1. Stick out your tongue as far as possible, draw with its tip an imaginary vertical line from the nose to the chin (several times).
2. Now draw vertical lines from left to right and vice versa.
3. Press your tongue against the upper incisors with force and prevent your mouth from closing.
4. Lick your lips in a circle, clockwise and counterclockwise.
5. Compress the jaws tightly and press the tongue on the cheeks, gums and palate.

Important! The main condition for the success of such training is its frequency and regularity. Remember to do these exercises with your baby several times a day.

A short frenulum of the tongue is not a disease, it is a physiological feature that has every chance of elimination if it is detected and properly treated in time.

Do not be afraid to consult a doctor if you suspect this pathology in your baby - after consultation, if necessary, start working on the problem as soon as possible, and soon everything will be fine for you.

Did you know? Classes with a speech therapist will be useful both as a non-drug treatment and in the postoperative time for correcting and setting the correct speech.

- a shortened sublingual ligament, which prevents the full range of movement of the tongue in the oral cavity. A short frenum of the tongue in a child disrupts the sucking function, 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 of treating a short frenum of the tongue in a child - conservative (stretching the ligament through articulatory gymnastics) and surgical (frenulotomy).

In total, there are three bridles in the oral cavity: the sublingual frenulum, the upper lip frenum and the lower lip frenum. The frenum of the tongue is a fold of mucous membrane that extends approximately from the middle of the lower surface of the tongue and attaches to the bottom of the oral cavity at a distance of 0.5-0.8 cm from the neck of the anterior incisors. The normal frenum of the tongue looks like a thin, stretchable cord that does not hinder 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 limit 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 stretched bridle should be at least 8 mm. If the child's frenulum is shorter, not elastic enough, abnormally attached, this condition is regarded as a short frenum of the tongue.

Causes of a short frenum of the tongue in a child

In almost half of cases, a short frenum of the tongue is inherited by a child from one of the parents. Non-hereditary cases of a shortened sublingual ligament can be associated with harmful effects on the embryo in the first trimester, during the formation of the dentition. 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, chemicals), etc. It is believed that small developmental anomalies are more common are found in children born to mothers over the age of 35.

In general, the reasons for the formation of a short frenum of the tongue in a child are not fully understood.

Classification of types of short frenum of the tongue in children

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

• thin, transparent, shortened frenum that limits the mobility of the tongue;
• a thin, translucent shortened frenum, attached by its front edge close to the tip of the tongue, which is why the tip bifurcates when it is lifted upward in the form of a "heart";
• 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 is tucked, the back rises with a slide;
• a short dense cord of the frenum is spliced ​​with the muscles of the tongue. Occurs in children with congenital clefts of the lip and palate;
• the tie of the bridle is practically not prominent; its fibers are intertwined with the muscles of the tongue, sharply limiting the mobility of the latter.

Symptoms of a short frenum of the tongue in children

Ankyloglossia in children can cause problems with feeding, the formation of speech function, the development of the dentition. The severity of functional disorders in a child with a short frenum 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.

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

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

The process of feeding a child with a short frenum of the tongue becomes tiresome for the mother and baby, and may be accompanied by painful sensations due to injury and cracks in the nipple. Ineffective sucking leads to lactation problems (hypogalactia) because it does not stimulate milk production. In this regard, a child with a short frenum of the tongue is often transferred to bottle feeding or artificial feeding.

In some cases, even with a short frenum of the tongue, the baby sucks correctly and gets enough milk. In such children, an anatomical feature in the form of ankyloglossia can manifest itself at an older age, during the period of the formation of speech function. The short frenum 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 polymorphic impairment of sound pronunciation, the child's speech becomes illegible and incomprehensible to others.

A short frenum of the tongue in a child can cause dental problems: open bite, prognathia, 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 frenum of the tongue may be disturbed by a cosmetic defect (V-shaped tip of the tongue), constant tears of the frenum, 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 and treatment of a short frenum of the tongue in children

Various pediatric specialists can diagnose and treat the pathology of the frenum of the tongue and its consequences: a neonatologist, pediatrician, pediatric surgeon, pediatric dentist, pediatric orthodontist, pediatric otolaryngologist, speech therapist.

Often, a short frenum 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 frenum of the tongue on the following grounds: the child cannot lick his lips, reach the upper teeth with his tongue, stick out the tip of the tongue from his mouth, etc. Medical specialists sometimes use the E. Hazelbaker test to assess the functionality of the lingual frenum.

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

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

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

Prognosis for a short frenum of the tongue in children

The prognosis for the treatment of a short frenum of the tongue in a child is in most cases good. Dissection of the frenum in a newborn is accompanied by an improvement in sucking, swallowing, breathing, and adequate weight gain. Early dissection of the short frenum 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 the short frenum 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 is required.

Conservative tactics for stretching the short frenum of the tongue in a child requires patience, systematic performance of the recommended exercises. This method is most effective in children under 5 years of age.

Every mother dreams of the perfect child. But anything happens. The most common, but at the same time, the most harmless defect in newborns may be a short frenum of the tongue. If the pathology is detected in the hospital, they try to eliminate it there.

However, many mothers are advised by doctors to wait, be patient, write them in the queue for surgery for a year, two, or even more. Why perform under-tongue bridle cutting in newborns, two- or four-year-olds when it is justified, and when it is quite possible to do without surgery?

And what kind of operation is this - plastic surgery of the frenum? At what age is it best to do it, what correction methods to use? We'll look into the most controversial aspects of this topic!

Purpose of the procedure

To understand why such an operation is being performed, it is necessary to find out what this bridle is.

So, the frenum of the tongue is a fold built from the mucous membrane of the oral cavity, which "protects" our tongue from falling back and keeps it in the anatomically correct position.

However, in some cases, there is a violation in its formation, the cells that should have collapsed remain and form a kind of groove, limiting the mobility of the tongue.

The consequences of this pathology are:

• inability to suck normally in infants;
• difficulty chewing food at an older age;
• serious problems in the formation of speech and the development of the speech apparatus - after all, we speak using mainly the mobility of our language;
• psychological problems associated with the inability to speak normally.

The procedure of plastic surgery of the frenum of the tongue in children is done precisely in order to "free" the tongue, to give the baby the opportunity to eat and speak normally.

Who determines the need for surgery

There are different opinions on this matter. Here is what the famous doctor Komarovsky says about the correction of a short frenum of the tongue in a child:
“A short frenum of the tongue always leads to two problems:

• difficulty in sucking;
• difficult speech.

The first problem is detected before the age of three months, the need for surgery is confirmed by the pediatrician. In the second case, only a speech therapist can recommend plastic surgery. In both cases, the problem can be solved very successfully in the office of a good dentist. "

At what age can you have surgery?

Fortunately for the parents, the plastic of the frenum and the operation can hardly be called. The essence of the event is that the baby is slightly "chipped" on the connective tissue. There is a minimum of blood, but what a freedom of action for the tongue! This is the whole point, dear parents! The operation can be performed:

• in the maternity hospital at birth, if the neonatologist sees this as an urgent need or the baby has problems with breastfeeding;
• in a year or two, if the baby has a problem with chewing food;
• at 4-5 years old, if the crumbs have problems with pronunciation due to a short bridle;
• never ever.

The most optimal option for at what age to cut the frenum of the tongue in children is considered to be a period of up to a year. The younger the baby, the easier it will undergo the operation. Because there is a concept "Speech rest mode". If the baby immediately begins to actively use the freedom granted to him, the seams may diverge, and these are additional problems and costs.

Many doctors prescribe an operation a year or two after your visit for a reason - for many children, the bridle stretches to the required length by itself, in the process of growth and maturation.

However, if the child has an urgent need for surgery, it is better not to put the problem on the back burner. The most correct thing is to consult a doctor and carefully study the possible options for correcting this tiny, but such an unpleasant defect in the structure of the baby's oral cavity.

Types of correction of the frenum of the tongue

Today, there are several types of plastics of the frenum of the tongue:

• Non-surgical correction. If the shortening of the frenum is insignificant, it is quite possible to do without surgery. It will be enough to regularly engage in exercises to stretch the bridle with the child. For example, stretching the tongue forward, "licking the jam" from the upper lip, reaching with the tip of the tongue to the upper and lower lips, and the like - you can learn more about them from a speech therapist. This correction can take months.
• Frenectomy... With this method, the bridle is trimmed with a scalpel or special scissors from the side of the teeth, and the edges are sutured. The operation takes about 20 minutes.
• Frenulotomy. In this case, the bridle is cut in the middle, suturing the free edges. On average, a doctor spends about 15 minutes on such a plastic.
• Frenuloplasty. This operation is performed in the most difficult cases. It is done in three ways - removing the bridle, cutting or moving the place of its attachment. The operation can take up to half an hour.
• Laser plastic. The fastest and most expensive way to correct a frenum is to simply burn out excess connective tissue by sealing the edges of the wound and sterilizing them with a laser. No stitches are applied, which simplifies postoperative oral care. Depending on the complexity of the case, the operation is performed from 10 to 15 minutes.

With any chosen method, the operation is performed using local anesthesia, so in any case, you will have to agree with the child so that he can sit quietly. This is one of the reasons why it is not worth tightening with plastic surgery - it is easier to hold a baby than a 5-year-old "bandit".

When choosing a plastic method, it is best to follow the advice of a specialist. Exercise will not always be effective. It is not always necessary for a child to endure stitches in the mouth after routine operations. In addition, they disagree if the baby is talkative.

Today, many leading experts are inclined to believe that cutting the frenum of a child's tongue is more effective and safer than using a laser; in this matter, one should not take into account only the price of the event - health and safety are most important.

Features of rehabilitation

The rehabilitation period directly depends on how the frenum of the tongue was corrected.

If there are seams:

• wound healing and suture resorption takes 7-10 days;
• in the first couple of days, it is better for the crumbs to be silent so that the seams do not disperse;
• in the morning, before going to bed and after each meal, you need to rinse your mouth with a solution of furacilin (you can also use a decoction of chamomile, calendula, oak, string);
• to form a soft scar at the suture site, it is recommended to start classes with a speech therapist from 3 days after the operation.

If laser correction was performed:

• wound healing occurs from 2 to 5 days;
• the first day it is better not to speak;
• it is advisable to rinse your mouth with antiseptic solutions 3-4 times a day, especially after meals.

In both cases, after correction, it is necessary:

• regularly

  This video clearly demonstrates the process of plastic surgery of the frenum of the child's tongue using special scissors.

  Plastic surgery of the frenum is a fairly simple, but sometimes extremely necessary operation for a child. In most cases, with proper postoperative care, it goes away without complications. Such a surgical intervention in the life of a baby has a number of advantages - from normal nutrition to well-delivered, intelligible speech.

  At what age and in what way to perform plastic surgery - it's up to you, we can only advise parents to listen to the opinion of specialists who are observing your baby. The main thing is that everything is good for the baby, which is what we wish you!

  Does your child have problems with a long bridle? Who did you contact with this question - a pediatrician or a speech therapist? What solution did your doctor recommend for you? If your child had a bridle plastic surgery, share with us in the comments which method you preferred.

The main attention of parents when assessing the health of the oral cavity in children is aimed at the absence of caries and inflammation of the gums, the formation of bite pathologies. But parents do not notice or even suspect about the presence of small, barely noticeable mucous folds, which can affect feeding, pronunciation of sounds, and even become a predisposing factor for the development of numerous diseases of the oral cavity. What are bridles, how many are there, when are they considered short, what are the consequences and, most importantly, what should parents do?

Table of contents:

How many bridles are there?

Everyone knows about the bridle of the tongue, it is constantly heard. Speech therapists, dentists, breastfeeding specialists and, of course, pediatricians talk about it. But they undeservedly forget about the rest of the bridles.

The bridle is a mucous cord that connects the anatomical structures of the oral cavity. There are three of them:

• a mucous fold woven into the upper lip and gums is called frenulum of the upper lip ;
• a strand similar in attachment, but only on the lower jaw - lower lip frenulum ;
• a fold woven with one end into the bottom of the mouth and the other into the tongue is called frenum of tongue .

Each mucous fold plays a role and has signs that indicate that it is shortened or normal. If, nevertheless, its shortening was diagnosed, then there are periods when the correction is carried out, and doctors give specific recommendations.

There are several ways to correct the situation: conservatively (with the help of classes with speech therapists) and promptly - in the surgical office of the dentist. Only a doctor can determine the scope of treatment, and a specific method of correction.

There are three main techniques used in surgical practice.:

• Phrenotomy - dissection of the bridle;
• Frenectomy - its excision;
• Frenuloplasty - moving the place of its attachment.

The choice of technique directly depends on the condition of the child, the clinical picture and the attachment of the frenum.

Phrenotomy Is one of the most common dental surgeries performed on newborns in the maternity ward.

Tongue frenum

Frenum of the tongue in newborns

After the baby is born, he is examined, his vital signs are assessed and he is applied to the mother's breast. If feeding the baby is impossible, then the doctors examine the oral cavity and assess the motor ability of the tongue, therefore, the frenum of the tongue. Normally, it should be attached approximately in the middle of the tongue, only such attachment does not affect or limit the movement of the baby's tongue.

In some babies, the bridle is woven into its very tip, which makes the tongue seem to be forked. But it is not this individual characteristic that is dangerous. Improper attachment will not leave an opportunity for the baby to fully suckle the breast. Due to the limitation of the motor ability of the tongue, the baby simply cannot lay the tongue under the mother's nipple, create the necessary vacuum for sucking.

note

Why children are born with shortened bridles is not known to science. Today this is considered an individual feature. Statistics show that such a diagnosis is widespread in pediatric dentistry and is given to every 10-12 baby.

If a short bridle interferes with feeding and even more so makes it impossible, then surgical intervention to correct it is carried out during the first few hours of life.

The dissection of the bridle always takes place in the presence of the mother, because the main condition is to immediately give the baby the mother's breast.

The mucous fold itself has no nerve endings, therefore, there is no need for pain relief. Phrenotomy does not belong to "bloody" operations, new mothers should not be afraid of it.

Doctors can dissect the bridle with surgical scissors or using a laser.

note

The laser is the most convenient and recommended method of surgical correction. Thanks to its use, it is possible to significantly reduce the period of rehabilitation and recovery: the edema is less pronounced, the risks of secondary infection are significantly reduced.

Frenum of the tongue in infants

The shortening of the frenum of the tongue is far from always manifested by such obvious signs. And nursing mothers can only notice problems after a while. ... Doctors remind you that there are symptoms that will help diagnose it and avoid the consequences:

• the appearance of smacking sounds during breastfeeding;
• long feedings when babies take long breaks;
• capricious behavior at the chest;
• insignificant weight gain, when the duration and frequency of feeding per day meets all the recommendations;
• signs in a nursing mother: painful sensations during breastfeeding, cracked nipples, etc.

The insufficient length of the frenum of the tongue also limits its movement. To obtain milk, the baby needs to spend more effort, he gets tired faster, while not receiving enough milk to saturate.

After examining the doctor, they strictly individually decide which surgical technique to choose: phrenotomy or phrenoectomy.

Tongue bridle in preschoolers and schoolchildren

It is possible to suspect that a preschool child has a short frenum of the tongue when speech defects appear. When children are unable to pronounce certain sounds, the pronunciation of which pushes the tongue away from the front teeth or palate.

Parents can independently determine the length of the bridle, and identify possible problems. To do this, just ask the baby to open his mouth and touch the sky with the tip of his tongue. If the child performs all the manipulations without difficulty, while not experiencing unpleasant sensations, there is no reason for concern. Otherwise, specialist advice is required.

note

This test has several disadvantages - the behavioral characteristics of children. It can be done for children at least 3 years old.

A shortened frenum of the tongue can be diagnosed at a prophylactic appointment with a dentist or at the consultation of an orthodontist regarding emerging or already formed bite pathologies. According to some dentists, a short frenum of the tongue will cause the tongue to be misplaced, which puts pressure only on certain areas of the jaw. Such selective pressure becomes the reason for the abnormal growth of the jaw - the main reason for the formation of bite pathologies.

Many dentists point out that a combination of several provoking factors is necessary for the formation of occlusion pathologies. And only one short bridle is unlikely to provoke such serious pathologies.

Dentist or speech therapist: which specialist to choose?

There are disputes between dentists and speech therapists concerning exactly how the shortening of the frenum of the tongue should be "treated". Speech therapists argue that the bridle can be pulled out with the help of speech therapy classes, dentists argue the opposite - it is much wiser to carry out a surgical operation, avoiding many consequences.

So who's right? In any case, after listening to all the arguments, the parents should make the final decision.

The case for speech therapists

Speech therapists, with the help of special exercises, will help the child to stretch the bridle to the desired size, while at the same time correcting the consequences of this condition: violations of the pronunciation of certain sounds.

Speech therapists say that up to 5 years, incorrect pronunciation of sounds is not always an indicator of pathology. Sometimes, this is just an individual feature of the formation of sounds, and after 5 years the problem can be solved by itself.

Speech therapists have strong evidence that their approach to correcting the situation is effective.

Many children, thanks only to speech therapy exercises, were able to stretch the bridle and pronounce the sounds correctly.

The case for dentists

Dentists use strict indications for surgical intervention, which are highly undesirable to expand or shorten.

Normally, the length of the bridle should be about 8 mm, it is this length that is sufficient for the correct functioning of the language, pronunciation of sounds and the absence of any consequences. Therefore, if the bridle is shorter, then surgical correction is necessary.

It is not practical to wait until the age of five and find out whether speech impairments do occur or whether this is an individual feature. It is much wiser to consult with a specialist and act immediately, avoiding many consequences.

Modern dentistry has unique methods of correction that do not leave unpleasant memories in the memory of babies. And the argument of speech therapists that surgery is a lot of stress for a baby is not valid.

Despite the fierce disputes between specialists, the "treatment" takes place practically in tandem of these specialists. After surgical treatment, a speech therapist begins to actively engage with the child.

Correction of the frenum of the tongue in older children

Surgical intervention

In children after 5 years of age, the frenulum is corrected mainly according to the frenulopastic technique - when the doctor, with the help of surgical instruments, changes the location of the tongue frenum.

The operation is carried out in a surgical room, under and lasts no more than an hour.

The operation is always carried out as planned, and if necessary, the doctors prescribe premedication or, in addition, the treatment with sedation is discussed with the parents.

Dentists can use a surgical scalpel, scissors, or laser scalpel as tools. It is more practical to use a laser. This will shorten the period of rehabilitation and recovery.

Excision and relocation of the bridle attachment site requires sutures. As a suture material, a material capable of self-absorption is used.

After the operation, the doctors give recommendations on the care of the oral cavity, which will prevent the addition of a secondary infection and the development of complications. Dentists provide nutritional advice. All irritating foods must be excluded from the diet during recovery: salty, spicy, fried, spicy. The food itself should not be hot or cold and it is recommended to grind it beforehand so that you have to chew less and load the tongue less.

Speech therapy exercises

After surgery, all young patients are advised to visit a speech therapist to correct the consequences, namely, to correct speech. Parents should understand that classes with a speech therapist will be long, lasting for several months. The main condition for success is to study not only with a speech therapist, but also at home.

All exercises are aimed not only at stretching and training the bridle, but also at correcting the incorrect pronunciation of sounds.

Parents should be aware that exercise will be challenging in the early days after surgery. In a short period of time, children get tired, begin to feel unpleasant and even painful sensations. Therefore, parents should increase the degree of activity of the classes gradually, while monitoring the condition of the baby.

Upper lip frenulum

The frenulum of the upper lip connects the lip and is woven into the mucous membrane of the alveolar process of the upper jaw. If the doctor says that the bridle is short, then it means its incorrect attachment.

note

Normally, it attaches a few millimeters above the front incisors, strictly along the midline. If the attachment occurs at the level of the cervical region of the anterior incisors or behind them, this is an indicator of pathology and correction is necessary.

Why is it dangerous?

A short frenulum is one of the causes of persistent gum disease... When talking, eating and chewing food, the bridle pulls the marginal gum section along with it. Such a chronic injury causes gum inflammation, which can develop into more complex diseases.

During puberty, many adolescents experience a special type of gum disease associated with hormonal changes. The addition of hormonal inflammation of the gums can complicate the course of the disease and provide a transition to.

If the bridle is attached behind the incisors, this becomes the cause of the formation of pathological three and diastemas - the gaps between the teeth. Children, especially girls, in adolescence can become complex about their appearance, withdraw into themselves, limit social contacts.

When and how should the bridle be corrected?

For surgical correction of the upper lip frenum, doctors use a strict time frame: 7-9 years, when the milk central incisors were replaced with permanent ones. Until this time, the mucous cord can change on its own!

It is best to carry out the correction when the central incisors have already erupted and the lateral... Due to their eruption, they can move the central incisors towards each other and close the diastema.

If during this period the bridle was not cut, then further closure of the defect can take place in several ways:

• orthodontic : to bring the central incisors closer to the central teeth, special brackets can be applied;
• therapeutic : aesthetic restoration with filling materials;
• orthopedic : production of orthopedic structures, for example, veneers, crowns, etc.

To correct the situation, doctors most often resort to frenotomy and frenuloplasty.

Lower lip frenulum

This is the most unique and "mysterious" bridle, which can be bifurcated or completely absent. When it is bifurcated, doctors use freectomy - excision of excess mucous cord.

To assess the frenum, doctors evaluate its attachment to the gingival mucosa. Normally, it should attach a few millimeters below the neck of the central incisors, in this case, its direction should coincide with the central line passing between the incisors.

What is the threat of such a condition?

This frenulum determines the depth of the vestibule of the oral cavity. An important indicator for full functioning.

Short frenum of the tongue

The frenulum of the tongue (frenulum linguae) is a fold of the oral mucosa that runs along the midline and connects the bottom of the mouth with the lower surface of the tongue (Encyclopedic Dictionary of Medical Terms, 1984). Sometimes the terms lingual ligament, sublingual ligament are used. The function of the frenum of the tongue is to fix the tongue to the soft tissues of the oral cavity, prevent tongue retraction, glossoptosis, especially during the neonatal period. Normally, the frenum 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 tongue of a child by the age of 18 months must reach at least 16 millimeters. Measurement of the absolute dimensions of the frenum of the tongue has not found wide application in clinical practice. It is believed that the length of the frenum of the tongue during the period of changeable bite should be at least 21 mm, and the width should not be more than 4 mm.

Fig. 1. Variants of attachment of the frenum of the tongue are normal. A valid attachment point to the lower surface of the tongue is highlighted in black. Green - to the mucous membrane of the floor of the mouth.

Short frenum of the tongue- one of the most common SMALL DEVELOPMENTAL ANOMALIES of the oral cavity organs. This pathology is sometimes called ankyloglossia. Ankyloglossia (ankyloglossia) - developmental anomaly: shortening of the frenum of the tongue from Ankilos - (Greek, curved, curved) a component of complex 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 is not widely used 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 frenum of the tongue is diagnosed in 2.3-19% of the subjects, and in boys it is reliably more often than in girls, a short frenum of the tongue occurs with a frequency of 1: 300 in newborns. Such a significant scatter of statistical data indicates the vagueness of the diagnostic criteria used, different principles of classification. The length of the short frenum of the tongue is no more than 1.7 cm, but at the same time, violations of the function of the tongue do not always occur, especially if the anatomically the frenum is located correctly.

Etiologically, a short frenum of the tongue is often due to a hereditary predisposition. There is also information about the significance of intrauterine trauma to the frenum of the tongue (when sucking a finger).

Clinical manifestations of a short frenum of the tongue.

During the period of the toothless oral cavity (up to 6 months), with the jaws closed, 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 about 3 mm. the tip of the tongue is located between them. The mobility of the tongue root 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 the closed lips, there is a visible tension of the facial muscles of the perioral region. In the future, the infantile type of sucking and swallowing is replaced by somatic when the tongue pushes against 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 bridle during the tension of the tongue, its tip is bifurcated in the form of a stylized heart, the edges of the tongue are raised (Fig. 2).

Fig. 2. Short frenum 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 bifurcated.

The child cannot lick the upper and lower lips. The back of the tongue rises when trying to stick it out, the tongue becomes curved, "humped". The short frenulum starts from the tip of the tongue or in its anterior third and attaches to the mucous membrane of the alveolar process of the lower jaw (Fig. 3). There are variants of ankyloglossi, when the bridle is attached in the area 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 “goose foot” (Fig. 4).

Even with a short bridle (less than 1.5 cm), if it attaches 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. Variants of attachment of the frenum of the tongue with ankyloglossia. The place of attachment of the frenum 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. The short frenum of the tongue is attached to the mucous membrane of the alveolar process in a fan-like fashion - in the form of a “goose foot”. The back of the tongue bends when you try to lift it.

As a result of tongue stiffness, caused by a short frenum, bite anomalies can form, the first signs of which during the period of temporary bite are the reversal of the central lower incisors to the lingual side.

Language functions.

The functions of the language 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 gustatory, temperature, tactile, pain. The pathology of the frenum 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 nutritional functions - chewing, swallowing, sucking, licking, licking, cleansing the oral cavity (spitting). The short frenum of the tongue can interfere with the implementation of these mechanical functions, mainly sucking. Licking and lapping are alimentary functions rudimentary for humans.

Language is one of the main articulators providing the function of speech. Speech is inherent only in humans, its physiological basis is second signaling system. The pathology of the frenum of the tongue does not affect the formation of speech as a whole, but only the formation of some sounds.

The aesthetic meaning of language plays a significant role in the socialization of the individual. Various "teasers", showing language, are typical for people of different ages, social status, races and nationalities.

Sucking.

Currently, the importance of the implementation of the sucking instinct during the neonatal period and breastfeeding (natural) feeding is not in doubt - “... it is in natural feeding that the real ways and possibilities of achieving biological perfection are laid within the framework of one's own species, the implementation and adjustment of the genetic fund, specific for the species forms of initial socialization ... The work of the muscular apparatus of sucking when feeding a child determines the emergence of efforts and stresses that most adequately regulate the anatomical formation of the dentoalveolar system, the cerebral skull, as well as the apparatus of sound reproduction "(Vorontsov I.M., Fateeva E.M., Khazenson L.B., 1993 ).

Sucking is an innate unconditioned reflex (instinct), formed during intrauterine 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 along 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, which provide the act of sucking. In the first weeks of a child's life, sucking is an 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 breast with his lips and gums, and more from the bottom than from the top, the nipple is at the level of the soft palate and does not participate in sucking. At the same time, the curtain of the palate is lowered. Tongue taking the form of a gutter descends 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 ensured 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 breast-sucking. When sucking a bottle, the child makes mainly retraction movements that provide the muscles of the cheeks and the translational movements of the tongue. In this case, the flow of milk is continuous.

Difficulty feeding during the neonatal period.

Contraindications to breastfeeding.

In the mother: especially dangerous infections (smallpox, hemorrhagic fevers, etc.), open form of tuberculosis, syphilis, decompensation of chronic diseases of internal organs, malignant neoplasms, acute mental illness, treatment with certain drugs. Contraindications to early attachment to the breast - operative delivery, large blood loss.

In a child: phenylketonuria, galactosemia, "maple syrup-smelling disease." Contraindications to early breastfeeding - Apgar score below 7.

Difficulty 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, alternating breastfeeding and bottle feeding. Changes in the taste and smell of milk when eating certain foods and medicines.

Fig. 5. Types of nipples. Difficulty or even inability to feed is caused by a depressed, poorly stretched 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", when the baby does not latch on to the breast, but mainly sucks on the nipple.

On the part of the child: child's diseases, both acute (ARVI, rhinitis, etc.) and congenital, birth trauma, etc. The child's fatigue when sucking is more often associated with neurological problems. The presence of microgenia, cleft palate creates significant problems when 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 the mother and the child does not reveal any pathology. The terms "lazy suckers" and "happy hungry" pretty accurately describe this problem. According to I.M. Vorontsov (1993) in such children, the maturation of the hypothalamic centers of hunger may be slowed down.

By itself, the presence of a short frenum of the tongue during neonatal and breastfeeding does not affect or slightly affects the quality of feeding. Especially if the short frenum of the tongue is attached in the soft tissue area of ​​the floor of the mouth, without causing stiffness of the tongue. In this case, the functionality of the language required for sucking is not impaired. Healthy children, with the correct feeding technique and the absence of other reasons, quickly adapt.

The only exceptions are the extreme variants of ankyloglossia, when the frenum of the tongue starts from the very tip and attaches to the apex 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 for speech production. The articulators are underdeveloped, the larynx is located much higher than that of 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, manifested in the form of babbling, not connected by conditioned reflex with primary signal radiators. By the end of the first year of life, the first words are formed that are used by the child for the purpose of verbal communication with people around him. A second signaling system is being formed. The child learns to form an image abstracted from the circumstances. Abstracting and systematizing complex concepts allows you to create first a passive and then an active vocabulary. At 2-3 years old, the development of phrasal speech begins. The 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 (Broca's center) in its work is associated with the centers of the 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 content aspects of speech.

There are three critical periods in the development of speech. The first (up to 2 years old) is the formation of the prerequisites for speech, the foundations of communicative behavior. The second (2.5 -3 years) - the transition from situational to contextual speech. Third - (6-7 years old) the beginning of the development of written language. The influence of unfavorable environmental and hereditary factors (acute and chronic diseases of the child, lesions of the central nervous system, anomalies of the articulators, insufficient socialization, etc.) can lead to impaired speech development.

Here are the definitions of some speech disorders.

Agrammatism- violation of understanding (the impressive side of speech) and use (expressive side of speech) the grammatical means of the language.

Agraphy and dysgraphia- impossibility (agraphia) or partial specific violation of the writing process (dysgraphia).

Alalia- the absence or underdevelopment of speech due to organic damage to the speech zones of the cerebral cortex in the prenatal or early period of the child's development.

Alexia and dyslexia- impossibility (alexia) or partial specific violation of the reading process (dyslexia).

Dislalia- violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus. Synonyms: tongue-tied, pronunciation defects, phonetic defects, phoneme pronunciation deficiencies. Dislalia maybe mechanical(wrong structure of articulators) and functional(no apparent anatomical reasons).

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-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- termination of speech 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.

OHR(general speech underdevelopment) - 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. ОНР can be I, II, and III levels. OHP can be complicated by dysarthria, rhinolalia, alalia, etc.

Rinolalia (nasal)- violation of the timbre of the voice and sound pronunciation, due to anatomical and physiological defects of the speech apparatus.

FFN(phonetic and 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, due to the short frenum, does not affect the general development of speech. The short frenum of the tongue can only contribute to the formation of some variants of dyslalia.

Treatment of patients with a short frenum of the tongue.

Indications to surgical treatment.

1. During the period of newborn and breastfeeding.

Severe sucking disorders. The child is not gaining weight. Significant stiffness of the tongue with an extreme shortening of the frenum (goes from the tip of the tongue to the apex of the alveolar process). At the same time, the child is somatically and neurologically healthy. Absence of reasons that impede breastfeeding on the part of the mother.

The 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 frenum 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 is a violation of the pronunciation of some sounds (mainly R, L).

Indications for surgical treatment are jointly determined by the dentist, speech therapist-defectologist if it is impossible to "stretch" the frenum of the tongue with the help of speech therapy massage and the ineffectiveness of speech therapy. In this case, it is necessary to clearly differentiate the types of speech disorders, tk. surgical treatment of ankyloglossia with OHR, dysarthria, delayed psycho-motor development can significantly aggravate the existing pathology.

To carry out an operation with a short frenum of the tongue in order to prevent possible speech disorders, especially at an early age, we consider not only inappropriate, but also harmful.

3. Indications for surgical treatment of patients with dento-maxillary anomalies and a short frenum of the tongue are determined by the orthodontist. Disorders of the bite, caused, among other things, by the unfavorable influence of the short frenum of the tongue, are characterized by the absence of a tendency towards 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 bite.

Anesthesia. We consider it unacceptable to carry out surgical treatment of patients with a short frenum 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 is significantly increased. Moreover, the floor of the mouth 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 parts of the tongue reflexively affects the cardiovascular and respiratory systems.

The use of local anesthesia during operations for short tongue frenum 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 anesthesiologist, while it is necessary to remember about the possibility of aspiration of blood and saliva during the operation.

Types of surgical treatment for patients with a short frenum of the tongue.

With any variant of surgical treatment of patients with a short frenum of the tongue, a preliminary laboratory examination is required (clinical laboratory minimum - clinical blood tests, urine tests, ALT)!

Frenulotomy- dissection of the frenum of the tongue (what is often called "cutting the frenum"). The tongue is lifted with tweezers or the back of a grooved probe at the site of attachment of the frenum to the lower surface of the tongue. The bridle is cut with scissors. No stitches are applied. This type of operation is used during the neonatal period. Some authors, justifying this technique, write about the so-called. The "avascular zone" of the thin and transparent frenum of the tongue during the neonatal period. We believe that with this type of frenum of the tongue, surgical treatment during breastfeeding is not indicated, because while there is no pronounced violation of the sucking function. We do not recommend using this method also in view of the possible complications. Bleeding, despite the widespread 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 frenum, cicatricial stiffness of the tongue (Fig. 6).

Rice. 6. Cicatricial shortening of the frenum of the tongue. Child 5 years old. At the age of three months, a frenulotomy (without suturing) was performed to prevent speech disorders. Pronounced mechanical dyslalia. An emerging progeny. Chronic desquamatous glossitis.

Frenuloplasty - localplastic lengthening of the cortical frenum of the tongue.

There are two types of frenuloplasty.

The first way. The bridle at the point of its attachment to the tongue is fixed with tweezers and dissected 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. For the ligature, the tongue is pulled up and anteriorly, while dissecting the bridle at the place of attachment to the lower surface of the tongue to the mouth of the excretory ducts of the hyoid salivary glands. The underlying fibrous cords are dissected and the tongue is mobilized. The resulting diamond-shaped defect is sutured "on itself" with catgut. This variant of the operation is a kind of V-Y plasty (Fig. 7).

Rice. 7. The diamond-shaped defect is sutured "on itself" while constantly pulling the tongue up and anteriorly by the holder. If the bridle is fan-shaped 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 in that, in addition, after partial suturing of the operating wound, plastic is performed with the figures of opposite triangular flaps 60 0 x 60 0.

When rough sutures are applied in the area of ​​the excretory ducts of the sublingual salivary glands, an acute retention of saliva may occur - the so-called. "Salivary colic". This rare complication associated with a violation of surgical technique develops within the first hours after surgery. In such cases, 1-2 sutures are removed and antibiotic therapy is prescribed to prevent sialodochitis.

Frenulectomy - excision of the frenum of the tongue. The frenum of the tongue is excised in a wedge-shaped manner and sutures are applied. A variant of frenulectomy is laser ablation. The disadvantages of this method include the lack of language mobilization.

Postoperative period generally runs smoothly . In rare cases, pain relief is required. Prescribe a sparing diet for one or 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.