Everyone can face such disorders as changing the aesthetics of a smile, difficulties in pronouncing a multitude of sounds and when chewing food, the feeling of a foreign body under the upper lip. One of the reasons is a defect in the normal formation and development of the bridle. The problem is not significant difficulties in terms of diagnosis and treatment regimen. Plasticization of the upper lip of the frenulum can be carried out by various methods: from dissection or excision with a scalpel to laser correction.
Why bridle is needed
The bridle is an elastic fold of the oral mucosa, which contributes to the constant maintenance of the lip in the correct position and limits its excessive abduction. This creates a microclimate of the vestibule of the oral cavity.
It is important! The length, location, elastic characteristics of the anatomical formation are strictly individual for each person. Indicators can vary significantly during the formation of the organism (especially in the first 5–7 years of life).
Normally, the upper lip frenulum is interwoven into the gum between two incisors at a distance of 5–7 mm from the neck of the teeth. It is invisible, does not feel and does not show through during the use of food, does not change the sound characteristics of the voice.
Any surgical intervention should be justified and applied only in severe cases, when there are signs of significant impairment of adaptation. Indications for plastic surgery are:
- Significant diastema (gap) between the lateral surfaces of the central incisors. The condition occurs when the end of the mucous folds interweaves in the region of the interdental papilla and forms a massive cord that prevents the incisor from taking the usual physiological position.
- Change the bite. Correction of the anatomical location of all the frenulums in the oral cavity is an integral part of the multistage correction of incorrect dentition closure.
- Periodontal diseases in which the roots of the teeth are bare. In this case, the frenulum “tightens” the mucous membrane from the surface of the teeth, making them more vulnerable to infectious (viruses, bacteria, fungi) and chemical agents.
- Violation of the act of chewing (less often - swallowing), change in speech (speech therapy problems, reduction of sound formation). In some situations, due to the short bridle or its ectopia, a violation of important social functions is possible. The main reason is the inability to lift the upper lip, the lack of participation of its round muscles in motor acts.
- Changing the aesthetic properties of the face. The problems include: smile defect or complete inability to smile, lack of lip movement (when sucking nipples, playing trumpet, kisses, etc.), gross anomalies (protrusion or inflow) due to improper attachment of the elastic fold.
- Wearing artificial limbs (especially with artificial gums). As a result, a too tight or large, improperly fixed smile creates a mechanical obstacle during the imposition of the dental framework.
- Frequent infectious and inflammatory diseases of the mucous membranes surrounding the bridle.Any abnormalities can reduce the factors of local immunity, lead to stagnation of saliva in pockets and active reproduction of pathogenic flora. Operative influence is made during remission. The indication is also the formation of connective tissue adhesions, developed during frequent exacerbations.
Persons with upper lip bridle vices in 30% of cases are carriers of other stigmas (small developmental anomalies).
Operational intervention is justified only at the age of 5-6 years, when all the basic elements of the oral cavity are already formed. The ideal period is the sprouting of the central incisors by 1/3 in the absence of the eruption of the lateral chewing elements. Earlier plastic surgery is a significant risk to the life of the child due to the frequent development of complications.
Despite the maximum ease of surgery and a small rehabilitation period, there is a certain list of conditions in which the implementation of plastic surgery is impossible:
- Active inflammatory processes in the oral cavity. The group includes stomatitis, gingivitis, caries of several teeth, periodontitis, etc. The presence of any source of chronic infection can lead to serious complications: from suppuration of the surgical suture to sepsis.
- Blood diseases associated with increased bleeding (thrombocytopenia, hemorrhagic purpura, leukemia). High risk of fatal bleeding.
- Benign and malignant proliferative processes in the oral cavity.
- Mental diseases in which the safety of the patient and medical staff during the intervention cannot be guaranteed (schizophrenia, any affective disorders).
- Autoimmune diseases with impaired synthesis and connective tissue architectonics (scleroderma, systemic lupus erythematosus, rheumatoid arthritis).
- Alcoholism or drinking within 3 days prior to surgery. The treatment is carried out under local anesthesia, ethanol significantly reduces the threshold of pain perception, as a result of anesthesia is ineffective.
It is also not recommended to manipulate the mucous membrane during the exacerbation of chronic somatic diseases (gastritis, pancreatitis) or during the course of diseases with severe immunodeficiency (HIV infection, taking glucocorticosteroids, etc.).
Technology of carrying
Operations of this kind do not pose a danger to the health of the patient and rarely lead to the appearance of dangerous complications.
Preoperative preparation is not carried out, the diet is not appointed. However, to exclude dangerous somatic and infectious pathologies that can significantly affect the outcome, the patient should undergo such examination methods as:
- General urine analysis;
- General blood analysis;
An important step is the selection of a local anesthetic. It is necessary to study the allergic history, since allergic reactions to the means used for local anesthesia are found in 3-5% of the world's population.
It is important! For suturing wounds, durable material is used that prevents the edges of the wound defect from diverging. The threads are preferably applied absorbable.
The duration of medical intervention usually does not exceed 15-25 minutes. The procedure is painless.
Frenotomy is the dissection of individual parts of the fold of the mucous membrane to reduce the tension of the surrounding tissues.
This type is the simplest.After treatment of the surgical field with antiseptic solutions (96% ethanol, Chlorhexidine, Iodinol), local infiltrative anesthesia is performed (Ultracain, Novocain). Then the bridle is dissected in the transverse direction at the border between the middle part and the area located closer to the dentition. After that, all muscle strands in the wound are dissected, and the upper lip is pulled out as much as possible. The side edges of the mucous membrane are tightened to each other, stitching is performed every 1-3 mm.
As a result of manipulations, it is possible to produce a significant lengthening of the frenulum without much injury to the soft tissues.
This option is more complicated technically. The scheme of the operation can be represented as follows:
- Treatment of the surgical field with anesthetic solutions.
- Conducting local anesthesia. In rare cases, the use of general anesthesia is allowed (for children). The application or infiltration method of local anesthesia is not capable of providing an adequate loss of sensitivity.
- The product of pulling off the upper lip in the vertical direction, followed by fixation.
- The imposition of the clip in the middle of the bridle.
- The implementation of two horizontally oriented converging cuts on each side of the clamp with the aim of excision of the "triangular" areas of the bridle.
- The detachment of the wound edges for the convenience of their tightening in the subsequent (ectopic distance - up to 2-3 mm).
- Suture closure. The location of the seams - horizontal.
With a short bridle of the lip and a small vestibule of the oral cavity, after additional excision of the bridle, two additional incisions in the form of a triangle are located on either side of the centerline of the body. Then the mucous membrane and periosteum are exfoliated in the apical direction. Is suturing. Operational incision resembles the letter of the English alphabet - "Y".
This type of correction of anomalies and pathologies of development of the upper lip frenulum has recently become widespread. Recognized technique of deepening the threshold of Clark. The steps are as follows:
- Antiseptic treatment of the intervention area.
- General anesthesia or conductive local anesthesia.
- The incision along the transitional folds of the mucous membrane to the depth of the periosteum.
- Exfoliation on the lip of the mucous flap up to 1 cm.
- The deepening of the vestibule of 7-10 mm. It is extremely rare to have more gum sedimentation - up to 15 mm.
- Stitching at the arch of the educated "new" vestibule and stitching to it a mucous patch.
- Coating the wound surface turunda, which is pre-wetted in an antiseptic solution - "Iodoform".
During healing with this method of fixation, the depth of the newly formed vestibule will gradually decrease, which may require repeated surgical interventions.
Medicine does not stand still, widespread practical application received laser equipment. The scheme of the operation is completely similar to the previous versions, but the manipulations are carried out using equipment that generates a light beam. The method has such advantages as:
- Sterilization of the wound (the laser effectively destroys all types of bacteria, viruses, fungi and protozoa);
- Bloodlessness (all edges coagulate, the chance of bleeding is negligible - less than 0.037%);
- No need for suture;
- Reduction of the rehabilitation period and quick return to the usual way of life;
- Formation of small areas of scar tissue;
- The absence of pain in the recovery gap.
Any operation does not always lead to the desired results and passes without a trace. Perhaps the development of such violations as:
- Change the bite. Due to the formation of connective tissue scars or excessive constriction of the mucous membrane during suturing.
- Deformation of the upper dentition (usually S-shaped).
- Change the contour and appearance of the upper lip. Due to incorrect adhesion, wavy outlines are possible, the appearance of areas of depression or swelling of the skin.
- Exposure of the root segments of the central incisors with the development of periodontitis and other diseases of the teeth.
- Thinning of the soft tissues surrounding the teeth. As a result, the mucous membrane in certain areas ceases to be moistened, the effectiveness of local factors of immune protection decreases, frequent stomatitis and gingivitis develop, which acquire chronic course over time.
- Bleeding Caused by injury of large supply vessels or by divergence of the wound edges.
- Infectious-inflammatory or purulent-septic complications. Implemented in violation of the rules of asepsis and antisepsis in the process of the operation, inappropriate care of the seam. Characterized by the presence of local abscesses under the mucous membrane, foci of osteomyelitis of the upper jaw, at least - sepsis.
In response to the introduction of local anesthetics, dangerous allergic reactions can develop. Most often observed:
- Urticaria - the rapid appearance on the entire surface of the skin or mucous membranes of papules of different diameters. After a few hours, the rash transforms into blisters with the presence of clear or hemorrhagic (blood) content. It is possible to merge individual elements with the appearance of massive cavities of decay. Normally after 1 day, all signs of a rash disappear without a trace.
- Pruritus is the formation of itchy areas that occupy individual fragments or all of the skin. The patient begins to itch, which significantly aggravates the general condition due to the danger of infection of wound defects and the development of severe complications: pyoderma, subcutaneous abscesses, and erysipelas.
- Anaphylactic shock - a sharp drop in blood pressure due to the relaxation of the smooth muscles of the middle wall of blood vessels and a decrease in total peripheral resistance. As a result, there are signs of inhibition of the activity of the central nervous system (up to a coma). The skin of patients is pale (rarely with an earthy shade), a lot of cold sticky sweat is separated. Early manifests respiratory failure (cyanosis of the limbs and nasolabial triangle).
- Quincke edema - edema that involves only subcutaneous fatty tissue of any anatomical formation of the body. With the “standard” flow, the lips, upper and lower eyelids are affected, less often - the mucous membrane of the oral cavity, larynx, trachea and bronchi. Respiratory failure may develop, followed by death from asphyxiation.
During the recovery period, in order to prevent infection and accelerate regeneration, it is recommended:
- Every day (at least 3 times a day), as well as after each meal, produce wound treatment with antiseptic solutions (hydrogen peroxide, "Chlorhexidine").
- In case of severe pain, apply applications with local anesthetic solutions. Ideal "Novocain" 10%.
- Refuse for a period of at least 3 weeks from the use of coarse or hard food, as well as sour, spicy, fried, salty. Such products can cause chemical and mechanical irritation of the seam edges.
- To conduct individually recommended gymnastic exercises that are aimed at the speedy recovery of chewing and facial muscles. A long period of muscle rest always leads to muscle atrophy.
- Avoid abuse of bad habits (alcohol consumption, smoking, taking drugs).
The price is significantly different depending on the geographical location, the profile of the medical institution (private or public), the qualifications of the dental surgeon.
|Procedure name||Minimum average price|
|Frenotomy||2 000 rubles|
|Phrenectomy||2 500 rubles|
|Frenuloplasty||5 000 rubles|
|Laser correction||4 000–6 000 rubles|
My daughter was still in the hospital (on the 5th day), and a frenulum was cut on the lip, then it was said that it was better to do it at an early age, otherwise she would not be able to suck milk and eat. I fed and fed her then without problems, my teeth grew even. Probably, I was very lucky that I got a good doctor and did everything at a young age, otherwise I would have suffered.
From school kompleksovat because of bulging upper lip. There are no other problems with the face and never have been. Parents were not in a hurry to solve the problem. On the day of birth, I allowed myself to please my boyfriend (honestly, I don’t know why) and do the surgery. The doctor was busy in the mouth for a maximum of 5 minutes. It turned out that the problem was a violation of the structure of the bridle (there were areas of high and low density). Now enjoy a chic smile!
Because of the huge bridle all my life I walked with a wide gap between my teeth. I always wanted to have surgery, I consulted more than once, but I was afraid. Finally decided. The doctors explained that because of the too thick bridle, laser correction cannot be done and will have to operate with a knife. Conducted under local anesthesia, everything went well. After 3 months, the gap gradually decreased (about 3 times), I hope in the near future to see your teeth in perfect order!
Video: upper lip frenulum plastic
Thus, at the slightest suspicion of the presence of abnormalities in the formation of the frenulum of the upper lip, it is necessary to contact a specialist as soon as possible in order to rule out violations of bite, speech defects and chewing in the future. Surgical intervention is carried out in a short time and does not represent a danger to human health. Compliance with all medical recommendations during the recovery period allows to achieve stable remission and is an excellent means of preventing infectious and inflammatory complications from the oral cavity.