Lingual Frenulum

Our mouth is a small part of the body that consists of several unique components. One among them is the lingual frenulum.

The lingual frenulum is a fold of oral tissue that forms a connection between the tongue and the floor of the mouth.

It is a tiny attachment that plays an integral part in controlling tongue movements in the mouth. The lingual frenulum usually develops in utero and continues to grow after birth.

This unique property allows the mouth to accommodate the tongue and confine its movement — ideally, lingual frenulum attached to the tongue on the lower side at the midline.

However, in some rare cases, the development of lingual frenulum can vary. This condition is known as ankyloglossia or tongue tie.

Commonly in ankyloglossia, the lingual frenulum can be short, thick or tight. In such circumstances, patients suffer from restrictive tongue movements. Furthermore, it makes chewing, speaking and swallowing difficult. (1)

Treatment of ankyloglossia is usually followed up when there is a hindrance in tongue movement. The excess frenulum is surgically relieved and allowed to heal.

Today’s article will highlight the unique characteristics of the lingual frenulum in the mouth and also shadow upon ankyloglossia and its treatment.

What is lingual frenulum?

A lingual frenulum, also known as, tongue web, is a small fold of oral mucosal tissue that attaches the midline of the under the surface of the tongue to the floor of the mouth. Usually, lingual frenulum develops in a ‘V’ shape with its base embedded into the floor of the mouth. (2)

This base consists of two largest salivary gland duct opening, called the Wharton’s duct. Wharton’s duct drains the saliva from submandibular and sublingual salivary glands out in the mouth.

Additionally, the lingual frenulum also hubs the opening of some minor salivary gland ducts.

Another vital structure that runs along the lingual frenulum is lingual veins, also known as varicosities. These veins are large and become prominent with age.

What are the characteristics of lingual frenulum?

Lingual frenulum starts to develop at around four weeks of fetal formation. The development of lingual frenulum controls the movement of the tongue in the mouth. (3)

During development, the tongue’s movement is negligible. However, as the tongue continues to develop, the cells of the frenulum undergo apoptosis. This process of cell degeneration retracts the frenulum attachment from the tip of the tongue and allows increased tongue mobility.

Lingual frenulum also plays an essential role in guiding forward growth of the tongue. This process eliminates the formation of short or thick frenulum attachment that may cause abnormal attachment.

What are some of the abnormalities and disorders associated with it?

Disturbances during the development of the lingual frenulum can have severe consequences among infants and adults. Furthermore, abnormal frenulum attachment may increasingly affect the nutritional and developmental milestones after birth.

Some of the abnormalities related to lingual frenulum may include –

  • Ankyloglossia- Also known as tongue tie. This congenital condition is characterized by the development of an abnormally short lingual frenulum. In such a circumstance, the tongue fails to protrude beyond the lower front teeth. Ankyloglossia in infants causes problems during breastfeeding and slower weight gain among the affected infants. (4)
  • Absence of lingual frenulum in the mouth may lead to hypermobility of the tongue. This condition is often associated with Ehlers – Danlos syndrome.
  • Traumatic lesions on the lingual frenulum often result in the formation of painful ulcers covered with fibrinous exudate with an erythematous halo. These ulcers may later turn into thick hyperplastic lesions.

The lingual frenulum is a very delicate and sensitive attachment in the oral cavity. Any disturbance in its development of growth may lead to a series of consequences. This mainly includes impairment of speech and difficulty in chewing or swallowing.

In such instances, early recognition and proper treatment plan are essential to healing the condition.

What are the treatments for abnormal lingual frenulum?

The treatment for abnormal development of lingual frenulum varies among infants and adults. A cure is only essential when there is a hindrance in the functioning of the tongue.

Let’s look upon the various treatment modalities that are followed to correct abnormal lingual frenulum –

Treatment among infants

In infants, tongue tie is usually the only problem that may occur as a result of abnormal lingual frenulum development. Severe cases of tongue-tie may undergo a surgical procedure called frenectomy.

Frenectomy is a simple procedure performed under anesthesia. In this procedure, the frenulum is snipped free from the under the surface of the tongue with the help of sterile scissors. Usually, the wound is tiny and heals on its own. After the procedure, the infant can resume back to regular breastfeeding.

Treatment among adults

Treatment for abnormal frenulum attachment is only recommended among adults when there is an interference with the patient’s quality of life. Generally, short frenulum attachment in adults leads to obstructive sleep apnoea. Furthermore, it interferes in the development of moth and jaw. (5)

In such cases, the surgical procedure of frenectomy is followed. Additionally, frenoplasty can also be done. Frenoplasty is a follow-up procedure, performed after frenectomy.

In this procedure, the wound is sutured to stop bleeding of the tissue and increase the rate of healing. Often it takes around 7-10 days for the site to heal completely.

Take away message

The tongue is a critical part of our oral cavity. It plays an essential role in speech, nutrition, and development of the mouth.

The lingual frenulum is one of the critical components of proper tongue functioning. The development and growth of the jaws, tongue, and mouth depends on the adequate attachment of lingual frenulum.

In some rare cases, the lingual frenulum may develop abnormally, causing several oral problems. One of the most common occurrences includes ankyloglossia.

Ankyloglossia leads to the formation of a short and thick lingual frenulum. Such attachment restricts the tongue mobility, interferes in speech and swallowing functions among infants. Additionally, it also causes obstructive sleep apnoea in adults.

Early recognition of any abnormal frenulum attachment can allow prompt treatment and healthy development of the oral tissues.

Seek care and advice from your dentist to recognize any such conditions. Stay informed and live healthily.