Fraenectomies

The surgical removal of fraenal attachments

Labial fraenectomy

Upper labial fraenectomy aims to remove or reposition the entire labial fraenum, including its attachment to bone, and to remove interdental tissue.

Labial fraenectomy should be delayed until after orthodontic treatment, unless it prevents closure of a diastema or shows evidence of trauma. A pronounced fraenal attachment extending into the palate may often be viewed radiographically as a V-shaped depression.

Technique Under LA the upper lip is firmly retracted, to assess the extent of the fraenal attachment. If particularly fibrous its whole length is outlined and excised with a scalpel, using an elliptical or rhomboid incision. Remaining attached fibres can be curetted from the underlying bone. The mucosa is then undermined and the defect closed with simple interrupted sutures. Patients are usually reviewed in 5 –7 days.

Lingual fraenectomy (release of tongue tie)

Lingual fraenectomies are occasionally recommended in younger children to assist in speech development. In older patients it may also be undertaken if tongue movement is so restricted that patients cannot reach the buccal surfaces of their upper molar teeth with their tongue. Rarely failure to undertake a lingual fraenectomy leads to periodontal problems in later life.

Technique

Performed under LA (GA for young children). Similar to that of a labial fraenectomy, although minimal, if any, tissue removal is required. The tongue is grasped and pulled upwards and the fraenal attachment is released using a single horizontal incision. The defect may be closed with simple interrupted sutures (resorbable). Care must be taken to avoid damage to the submandibular salivary duct openings.