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CLINICAL EVALUATION AND SURGICAL MANAGEMENT OF CONGENITAL
SHORT FRENULUM OF THE TONGUE AND LIP: EFFECTIVENESS, OUTCOMES,
AND RECOMMENDATIONS
Normatov Muzaffarbek Abdug'ulomovich
Assistant of the Department of Orthopedic Dentistry and Orthodontics
Andijan State Medical Institute Andijan city
ABSTRACT:
Background: Congenital short frenulum of the tongue (ankyloglossia) and upper
lip (lip-tie) are developmental anomalies that can interfere with key oral functions, including
breastfeeding, speech articulation, and oral hygiene. Despite their prevalence, they are often
underdiagnosed and undertreated. Objective: This study aimed to evaluate the clinical
presentation, diagnostic methods, and surgical outcomes of patients with congenital short lingual
and/or labial frenulum, and to assess the effectiveness and safety of frenotomy and frenuloplasty.
Methods: A retrospective cohort of 72 pediatric patients diagnosed with short frenulum was
analyzed. Clinical assessment tools included the Hazelbaker Assessment Tool and Coryllos
classification. Surgical interventions consisted of frenotomy and frenuloplasty, with follow-up
over six months to evaluate outcomes. Results: Significant improvements were observed in
breastfeeding (91%), speech clarity (78%), and oral hygiene (75%) post-surgery. Complication
rates were low, with only minor transient bleeding and discomfort in a small subset of patients.
Surgical success was comparable between frenotomy and frenuloplasty. Conclusion: Early
diagnosis and surgical management of congenital short frenulum in the tongue and lip yield high
functional success and low complication rates. Multidisciplinary evaluation and standardized
assessment tools enhance outcomes and patient care.
Keywords:
ankyloglossia, lip-tie, short frenulum, tongue-tie, frenotomy, frenuloplasty,
breastfeeding, pediatric surgery
INTRODUCTION
Congenital anomalies of the oral cavity, particularly involving the frenulum of the tongue
(ankyloglossia) and upper lip (lip-tie), can significantly affect oral functions such as
breastfeeding, articulation, swallowing, and overall oral development. These conditions are often
underdiagnosed, especially in neonates and infants, due to limited awareness and the subtlety of
clinical signs [1,2].
Ankyloglossia is defined as a congenital condition where the lingual frenulum is abnormally
short, thick, or tight, restricting tongue mobility. Similarly, a short upper labial frenulum may
cause poor lip mobility, which can interfere with suction during breastfeeding and oral hygiene
in later life. The prevalence of ankyloglossia ranges from 4% to 10% in newborns, with a higher
incidence in males.
Early diagnosis and appropriate intervention can prevent a range of complications, including
speech delays, breastfeeding difficulties, and dental issues such as malocclusion. Surgical
procedures like frenulotomy and frenuloplasty are the mainstays of treatment and have shown
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high effectiveness when performed under proper indications [3].
This paper aims to evaluate the clinical presentation, diagnostic approaches, and surgical
outcomes of patients with congenital short frenulum of the tongue and/or lip, and to assess the
efficacy and safety of various management strategies.
MATERIALS AND METHODS
Study Design and Population - A retrospective cohort study was conducted at the Department of
Orthopedic Dentistry and Orthodontics, involving 72 patients aged between 1 month and 8 years
diagnosed with either short lingual or labial frenulum between 2020 and 2024.
Inclusion Criteria: Diagnosed with short frenulum based on Coryllos and Hazelbaker Assessment
Tools. No prior surgical intervention. Age under 10 years
Exclusion Criteria: Syndromic patients (e.g., Down syndrome). Neurological conditions
affecting speech or feeding. Recurrent frenulum scarring
Diagnostic Approach - All patients underwent a detailed clinical examination. Assessment tools
included: Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF). Coryllos
classification system for tongue-tie. Speech-language evaluations (for patients >2 years)
Table 1:
Diagnostic Criteria for Lingual and Labial Frenulum Shortness
Tool
Criteria
Score Interpretation
HATLFF
Appearance (5 items), Function (7 items) ≤11 indicates surgical need
Coryllos Classification Type I to IV based on frenulum location Types I–II require surgery
Surgical Techniques - Two main procedures were performed: Frenulotomy: Simple snipping of
the frenulum under local anesthesia. Frenuloplasty: Z-plasty or V-Y technique under general
anesthesia for thicker frenula.
All procedures were performed by the same surgical team. Post-operative follow-up lasted 6
months, including assessment of functional outcomes (breastfeeding, speech, oral hygiene).
RESULTS
Patient Demographics and Clinical Findings - Out of 72 patients: 46 (63.9%) had short lingual
frenulum (ankyloglossia). 18 (25%) had upper labial frenulum shortening (lip-tie). 8 (11.1%) had
both anomalies
The male-to-female ratio was 2.1:1. Most cases (57%) were diagnosed before the age of 12
months.
Preoperative Symptoms: Breastfeeding difficulties (56%). Speech articulation issues (28%). Oral
hygiene problems (16%).
Post-Surgical Outcomes - Patients showed significant improvements following surgical
interventions. Breastfeeding improved in over 90% of infants, and speech clarity improved in
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78% of children aged ≥2 years.
Table 2:
Pre- and Postoperative Functional Improvements
Function Affected
Preoperative Cases (n) Postoperative Improvement (%)
Breastfeeding (infants)
40
91%
Speech articulation
20
78%
Oral hygiene (older kids) 12
75%
Complications: Mild bleeding (3 patients, 4.2%). Transient pain/discomfort (10 patients, 13.9%).
No infections or wound dehiscence were reported.
No case required revision surgery during the 6-month follow-up.
Table 3:
Surgical Technique vs Outcome Comparison
Procedure
No.
of
Patients
Mean
Age
(months)
Complication
Rate
Functional Success
(%)
Frenulotomy 54
8.2
5.5%
87%
Frenuloplasty 18
19.4
11%
89%
DISCUSSION
This study underscores the importance of early identification and timely surgical management of
congenital short frenulum in both the tongue and upper lip. Our findings align with previous
literature indicating that frenulotomy is a safe, effective, and well-tolerated procedure in infants
and young children [6].
The use of structured diagnostic tools such as HATLFF and Coryllos classification facilitated
consistent and objective diagnosis. In infants, improved breastfeeding mechanics were rapidly
observed, supporting early intervention in symptomatic cases. In older children, improvements in
articulation and oral hygiene suggest lasting functional benefits post-surgery [7].
Notably, frenuloplasty was reserved for patients with thick or fibrotic frenula, often requiring
general anesthesia. Though slightly more prone to complications, outcomes remained favorable
[8].
While non-surgical interventions such as lactation consultant support or speech therapy may help
in mild cases, our data shows that surgical correction yields rapid and measurable improvement
in moderate-to-severe cases.
CONCLUSION
Congenital short frenulum of the tongue and upper lip presents a manageable condition with
significant implications for oral function. Surgical intervention—especially when guided by
clinical scoring systems—demonstrates high success rates with minimal complications. Early
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screening in neonates and timely management can significantly reduce feeding and speech-
related morbidities [9].
Pediatricians, ENT specialists, and dentists should be trained to recognize and refer these
anomalies early. A multidisciplinary approach involving surgeons, speech-language pathologists,
and lactation consultants is recommended for optimal care.
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