The labial frenulum: how does it work and why may surgery be necessary?

The labial frenulum connects the alveolar ridge to the inside of the lip. If it has grown too short, it restricts the mobility of the lip, which can lead to difficulties with breastfeeding, tooth eruption, tooth cleaning, speaking and eating. During breastfeeding, the lip is not turned up far enough for physiological drinking. The baby cannot create a vacuum and presses the jaws and lips together when feeding. This opens the corners of the mouth, milk runs out and air is drunk noisily along with it. It is therefore advisable to remove this adhesion as early as possible. The membrane connecting the lip and the alveolar ridge is cut or lengthened by means of a short operation.

Before the procedure

At the beginning of a successful operation, there is a detailed discussion and examination of the oral cavity and lip function with the attending physician. If it is determined that medical advice or intervention is needed, appropriate action will be taken. In addition, the child must be completely healthy at the time of surgery.

What happens during the procedure?

In the classic lip ligament separation procedure, the lip is first pulled up and held in place. Then the frenulum can be cut. More commonly, however, frenoloplasty is performed. The doctor makes a Z- or V/Y-shaped incision in the frenulum of the lip with a scalpel, resulting in a lengthening. Alternatively, the tongue frenulum and lip frenulum can be separated with scissors. The surgery is performed either under local anesthesia or anesthesia.

The tongue tie center separates ligaments with a numbing gel and/or local anesthesia using the superpulsed CO² laser in a few seconds.

What are the effects of the procedure?

The upper lip can now be turned up during drinking without stress, the vacuum can be held and swallowing of air is prevented. In the case of deciduous teeth, good and stress-free cleaning of the anterior teeth is possible after wound healing is complete and the permanent teeth are not disturbed or distracted during eruption. The gingival margin is protected from recession.

How do I recognize a frenulum that is too short?

The labial frenulum is usually easy to see, especially when it attaches to the very top of the alveolar ridge. Not every doctor, lactation consultant IBCLC or nurse has enough experience and knowledge to examine this accurately and identify a problem especially in borderline cases. Therefore, it is important to consult a dental office, in advance should send a photo. A short lip band often causes narrow lip shape. Often a shortened labial frenulum is genetic and restricts the mobility of the lips, ineffective breastfeeding and sucking is the result.

Is it possible to stretch the frenulum?

The lip frenulum is made of collagen, which is only slightly stretchable. The lip is stretched, which can lead to short-term improvement of symptoms in borderline cases. If the stretching exercises are stopped, the symptoms often return or other symptoms appear as compensation. However, the alveolar ridge continues to grow, so the attachment point of the labial frenulum may change as a result.

What are the disadvantages of cutting the frenulum that is too short?

It is though very minimally invasive surgical procedure. A scar may develop. The main disadvantage in infants are active wound management for at least 4 weeks every 4-6 hours even at night. This can be uncomfortable for infants and stressful for parents.

What are the costs of cutting the frenulum?

In Germany, the statutory health insurance does not usually cover separation with laser. Also, not all private insurances cover the costs, as the billing is analogous, since this minimally invasive procedure as it is performed by us is not included in the service catalog.

Does the frenulum that is too short cause problems in the toddler, school child and adult?

Dirt pockets can form in the milk teeth, the risk of caries increases, brushing and biting can be difficult or painful. The permanent anterior teeth have an increased risk of erupting with a gap. The strong pull of the labial frenulum on the gumline can cause the gum to recede and expose the neck of the tooth.

What are the consequences of not cutting the frenulum that is too short?

Not detected early enough and left untreated, not only breastfeeding becomes difficult, but later in life, problems with eating, teeth and gums occur. Therefore, many specialists advise to treat the shortened frenulum.