(frenulum of the tongue)

Presence of a frenulum that is too short or inserted too distally on the tongue. Could be present in 5-10 % of newborns. 

One distinguishes:

-        anterior ankyloglossia: where the frenulum is inserted at the tip of the tongue (type I) or too close to it (type II), reducing the mobility of the anterior part of the tongue

-        posterior ankyloglossia: where the frenulum is very thick (type III) or hidden under a mucosal elevation without the presence of a real external frenulum (type IV, reducing the mobility of the posterior part of the tongue

-        superior ankyloglossia (see this term).

The impact on breastfeeding and the learning of speech of the partial form is the topic of many controversies.

The defect can be corrected by frenectomy (section of the frenulum over a grooved probe) or frenotomy or frenectomy. The frenectomy is a short and minor intervention, often carried out at the office of the pediatrician. Note that there is an artery in the frenulum of the tongue and a few cases of hemorrhage have been described.

Anesthetic implications: 

complete ankyloglossia may interfere with direct laryngoscopy; anesthesia for frenotomy can be performed with a facial mask (small mask applied on the nose during the intervention) or with a nasopharyngeal airway.

References : 

• Geddes DT, Langton DB, Collow I, Jacobs LA et al. 
  Frenulotomy for breastfeeding infants with ankyloglossia : effect on milk removal and sucking mechanism as imaged by ultrasound . 
  Pediatrics 2008; 122: e188-e194
• Opara PI, Gabriel-Job N, Opara KO. 
  Neonates presenting with severe complications of frenotomy: a case series. 
  J Medical Case Reports 2012; 6:77

Updated: November 2019