Problem: for a consultation with the Dial-Dent speech therapist T.B. Zukor was contacted by a 22-year-old man. His wish: “We urgently need to trim the frenulum of the tongue! The surgeon needs a referral from a speech therapist to perform the operation!” The reason for this urgent treatment was unbearable pain in the tongue area when kissing!
Solution: myofunctional examination confirmed the need for frenuloplasty of the tongue (surgery to trim the frenulum of the tongue). The man received a referral for an operation, which was performed by surgeons at the clinic. Frenuloplasty of the tongue was successful, the pain was completely eliminated.
The speech therapist of the Family Dental T.B. talks about the short frenulum of the tongue, how to identify it, and what to do with it. Zukor in his article.
Short frenulum of the tongue - how to determine?
Symptoms of a tongue frenulum are usually identified by a speech therapist during a myofunctional examination. Most often, specialists (this can be attentive parents or the patient himself) observe the following symptoms:
- Limitation of tongue mobility; it is difficult for the patient to move the tongue out of the mouth and raise the tip of the tongue to the upper lip.
- The tip of the tongue bifurcates when you try to push it forward.
- The patient pronounces the sound L incorrectly, making it sound like V.
- Sometimes a short frenulum of the tongue brings purely everyday discomfort, as in the clinical case described above.
Short hyoid frenulum
- Speech therapist.No
- Consultations
- Short hyoid frenulum
During the consultation, you were told that the child has a short hyoid frenulum and in the future it will most likely need to be trimmed. What to do?
Hyoid frenulum
The sublingual frenulum is a membrane that is located under the tongue and connects the tongue to the sublingual space.
How to determine whether the hyoid frenulum is long enough?
Indeed, in different people the hyoid ligament (frenulum) can be of different lengths. If a child can stick his tongue out of his mouth and at the same time its tip does not bifurcate in the shape of two semicircular petals due to the fact that the hyoid ligament pulls it from below, if he can lick the saucer and click his tongue, then he will most likely have no obstacles for making sounds that require raising the tongue to the palate.
In a 5-year-old child, the frenulum in a stretched state should be at least 8 mm.
Short hyoid frenulum
A short hyoid ligament (frenulum) is a congenital defect consisting of shortening of the lingual frenulum (hyoid ligament).
What does this mean?
Short hyoid frenulum:
- may cause difficulty in tongue movements, because does not give him the opportunity to rise high. In this case, the so-called “upper sounds” suffer, i.e. the pronunciation of sounds such as Ш, Ж, Ш, ШЧ, Р, Рь is impaired
- can lead to a displacement of the center of the tongue, its asymmetrical development and low mobility, which prevents the formation of the correct articulatory posture of some sounds.
- may also be the cause of a violation of diction (Diction is clarity, intelligibility of pronunciation)
- in some cases, it can provoke problems with the formation of the lower jaw, i.e. The teeth may deviate and the necks of the teeth may become exposed. There is a risk of developing periodontitis and gingivitis. Therefore, a consultation with an orthodontist is necessary.
What to do?
There are two options to solve the problem:
- Stretching the hyoid frenulum
- Surgery
Stretching the hyoid frenulum
- This is reasonable if the frenulum is not very short, otherwise stretching a very short frenulum, according to some doctors, can lead to sagging of the mucous membrane, etc. the problems described above (periodontitis, gingivitis).
- Stretching is most successful up to 5 years of age. And the older the child, the more difficult it is.
- Stretching does not cause as much stress to the child as surgery, but it takes significantly more time and effort. After all, the corresponding exercises need to be performed several times a day, every day, and on a positive wave.
- Stretching with the help of speech therapy massage is an unpleasant process, often very painful for the child.
- Surgery is often easier for some parents.
Even if the frenulum is somewhat shortened (equal to 8 mm), it is better to stretch it than to operate
Many exercises can be started from a very early age. Remember! The baby will not be able to sit with you in front of the mirror and do the exercises according to your instructions. Turn everything into a game.
Exercises for the little ones
1) Lick the saucer. Invite your child to lick the saucer like a kitten.
2) Reach with your tongue for the spoon 3) Reach with your tongue to your chin 4) Reach with your tongue to your nose 5) Swing open your mouth, with the tip of your tongue reach first to the nose, and then to the chin, then again to the nose, and then again to the chin. 6) The horse smile, open his mouth. Click the tip of your tongue like a horse clicking. The mouth is open, the tongue should be wide. Make sure that the tip of the tongue does not turn inward, and that the lower jaw remains motionless. You can sit on a toy horse (if there is one in the house), or you can sit on your mother’s lap.
Exercises for older children
Along with the previous ones, you can do the following exercises:
1) Delicious jam: open your mouth slightly, the tongue moves along the upper lip from top to bottom, but not from side to side (as if licking the jam). The lower jaw should be motionless. 2) The painter invite the child to use his tongue, like a “brush,” to paint the ceiling in the “house” - the mouth. To do this, you need to open your mouth and stroke the palate with the wide tip of your tongue, making movements back and forth (from the teeth deep into the oral cavity and back). 3) Drum Show your child how to imitate a drum by beating a beat with your tongue. To do this, you need to open your mouth, smile slightly and, with the tense tip of your tongue, tap on the alveoli (tubercles behind the upper incisors), repeatedly and clearly, in one breath, pronouncing the sounds “D-D-D.” Tap slowly at first and then increase the tempo. Ask the child to repeat. Make sure that the child does not close his mouth during the exercise. 4) The fungus opens its mouth wide, presses the wide flat of the tongue against the palate and sucks it. Hold your tongue in this position for 5-10 seconds. The tongue will resemble the cap of a fungus, and the stretched hyoid ligament will resemble its thin leg. Then, “unstick” your tongue and close your mouth. Repeat the exercise 2-3 times. 5) Accordion Show your child how to draw an accordion using your tongue. To do this, you need to suck the wide tip of your tongue to the roof of your mouth, as in the “Mushroom” exercise, and then, without peeling off your tongue, open and close your mouth. The hyoid ligament (frenulum) will act as an accordion, which either stretches to its full length, then contracts.
Remember!
- Exercises must be performed systematically, gradually increasing the time they are performed (the number of repetitions of each exercise), only then will the desired effect be achieved.
- The sooner you start classes with your child, the faster you will achieve the desired result.
- The older the child, the more difficult it is to stretch the hyoid frenulum (targeted stretching of the hyoid frenulum using speech therapy massage is an unpleasant procedure, quite painful for the child). Stretching is most successful up to 5 years.
Surgery
Surgery is always stressful for a child
- You need a good doctor and modern equipment. Good reviews about the consequences of operations under local double anesthesia. But this is the doctor's choice.
- If something goes wrong, there is a risk of scar formation, making it difficult for the tongue to move.
- Short period of time for correcting sound pronunciation.
- After cutting, the hyoid ligament can grow back together if you don’t start working on it in time, i.e. no earlier than 10-14 days and no later than 1 month. after operation.
- Sometimes surgery is recommended for medical reasons by an orthodontist, not only because of shortcomings in sound pronunciation. If you do not trim the hyoid frenulum, then SOMETIMES there is a risk of periodontitis, gingivitis (bleeding, exposure of the necks of the teeth), large gaps between the teeth, deterioration of the natural self-cleaning of the oral cavity... But this is not immediately visible, everything is in the distant future... And it happens far from everyone, only a doctor can qualify such a case.
Methods for eliminating a short frenulum of the tongue
A short frenulum of the tongue is corrected surgically. The most modern method is cutting the frenulum of the tongue with a laser, since there is less pain, the operation is almost bloodless, the wound is sterile and heals quickly.
Operations can be different:
- Frenuloplasty of the tongue is plastic surgery of the frenulum of the tongue with mobilization. Mobilization is the preparation of the edges of the wound for a screed by pulling the tongue forward and upward; flap formation is often used in plastic surgery. In most cases, frenuloplasty of the tongue is the most favorable way to lengthen the frenulum for both healing and restoration of the tongue.
- Frenulotomy is a dissection of the frenulum, usually done in the maternity hospital by simply cutting the frenulum without sutures.
- Frenulectomy - excision of the frenulum. During this operation, the doctor cuts the tissue wedge-shaped in several places, then applies sutures, but does not mobilize the tongue. This is a disadvantage of the method.
Obviously, each case is individual and the choice of method should be made by a specialist.
Reasons for the development of pathology
In the vast majority of cases, a short frenulum is a consequence of a developmental abnormality and is combined with phimosis - a narrowing of the foreskin with the impossibility of exposing the head of the penis. According to statistics, up to 5% of uncircumcised men suffer from insufficient extensibility of the folds of skin on the penis. This anomaly is accompanied by a number of painful and unpleasant symptoms:
- curvature of the penis in an erect state;
- pain during sexual intercourse;
- premature ejaculation;
- the frenulum breaks as a result of active movements during intercourse.
With normal development, the frenulum is of sufficient length and can stretch significantly, providing comfortable and painless movement of the foreskin. A fold of skin that is too short causes a lot of trouble and can cause serious complications.
What is a short frenulum of the penis?
The frenulum is a skin bridge, a cord that holds the foreskin so that it does not go far beyond the coronary groove. A shortened frenulum of the penis often does not allow the head to be completely exposed (phimosis), as a result of which it is impossible to wash out accumulated discharge (smegma) from the resulting fold. Inflammation (balanoposthitis) often develops on this basis. Hard formations (smegmalites) may also appear. If the infection gets into the urethra and begins to rise along its walls, urethritis, cystitis, and prostatitis will develop.
During an erection, the short frenulum is strongly stretched, causing pain. Sexual intercourse, even with a condom, will be very painful. It is necessary to restrain the frictions, since a tense frenulum is easily torn, which is accompanied by severe pain and bleeding. Healing sometimes fails - it becomes even shorter, becomes deformed, and then surgery cannot be avoided.
Interview on the topic “Short frenulum of the foreskin” with Nika Dzhumberovich, Doctor of Medical Sciences, Professor of the Department of Urology at Sechenov University, Head of the Department of Male Sexual and Reproductive Medicine at the European Medical Center Akhvlediani
A short frenulum can cause premature ejaculation. Not only blood vessels, but also nerves pass through the thickness of this skin fold. During tension, the sensitivity of this area intensifies.
A short frenulum can also affect the shape of the penis, pulling the head down. As a result, during an erection it cannot fully straighten and looks shorter.
Deformation of the penis with a short frenulum
A short frenulum may be this way from birth or deformed due to injury. In the latter case, the problem most often arises due to too active sex or masturbation. The frenulum tears, then grows together, but the connective tissue is no longer so elastic. As a result, the foreskin ceases to completely expose the head.
Causes of pathology in adolescents
At the age of 13-18 years, rapid development of the genital organs occurs and the reproductive system is formed. This period is characterized by the possible occurrence of hormonal imbalances, as well as disruption of the normal functionality of certain systems and organs.
It is during puberty that there is a high probability of a discrepancy between the growth rate of skin tissue and the rapidly developing cavernous bodies in the penis.
As a result of the rapid onset of puberty, the frenulum of the penis becomes short in comparison with the size of the organ itself and is unable to painlessly perform its functions - to help the foreskin cover the glans.
If a teenager in this state begins to have sex (masturbation), there is a high probability that the skin fold will rupture or cracks will appear on it. Mini-damages of this kind must be treated with an antiseptic and consult a doctor.
Otherwise, not only mechanical damage, but also psycho-emotional discomfort may occur.
In the long term, this can lead to a decrease in confidence in one's sexual capabilities. And even cause impotence. During adolescence, not only puberty occurs, but also psychological foundations are formed. Therefore, the young person is especially vulnerable.
Reviews about the treatment
Judging by the reviews on the forums, the result of frenulum correction depends on the skill of the doctor. For some, the sensitivity of the head disappears and its blood supply is disrupted. An example of a review and the doctor’s response is below.
UVT and other procedures did not help the guy. Most clinics also do not undertake microsurgical operations.
Due to the unprofessionalism of doctors or poor hygiene, the operation has to be redone. After the first failure, many turn to famous doctors - Petrovich R. Yu. and Bakirkhanov S. K., as in the review below.
Bakirkhanov’s answer to the question about sensitivity after surgery:
For most men, the correction is successful.
