Frænectomy / Tongue-Tie Release
Explanation & Warnings
A frænum is a band of fibrous tissue that links the lips
to the gums or the tongue to the gums.

Upper Jaw Frænum.

A ‘high’ or prominent upper
frænum in children, although a
common finding, is often a concern, especially when
associated with a
diastema (a space between 2 teeth such
as the upper central incisors).  Treatment is necessary
only when the
frænum exerts a traumatic force on the gum
or it causes a
diastema to remain open after eruption of
the permanent canines / ’eye’ teeth.

In an older child, if a
frænum is present and the tissue
immediately behind the central incisors on the roof of the
mouth side of the teeth blanches when the upper lip is
pulled, removal of the
frænum is indicated.

Early treatment is also indicated to prevent subsequent
inflammation, recession of the gum around the spaced
teeth, pocket formation within the gums and the possible
loss of the bone supporting the teeth and/or teeth

Tongue Tie / Ankyloglossia.

Tongue Tie / Ankyloglossia is characterised by a short,
thick fibrous band linking the tongue to the gum just behind
lower central incisors.  It limits the movement of the

The significance and management of
ankyloglossia are
controversial.  Studies have shown a difference in
treatment recommendations between
Speech Therapists,
Pædiatricians, Ear, Nose & Throat Surgeons and Oral &
Maxillofacial Surgeons
.  Most professionals, however, will
agree that there are certain indications for

tongue tie can limit tongue movement and create
swallowing problems.  A
frænectomy for functional
problems should be considered on an individual basis.

tongue tie can lead to problems with breastfeeding,
speech, how teeth bite together and potential gum disease
and gum recession problems.  The
frænectomy will only be
done if evaluation shows that function will be improved by

If you are to have your
frænum removed, you can expect
the following.  This list is not exhaustive but it is predictive.

The most pertinent warnings have been included here.

Pain.  As it is a surgical procedure, there will be soreness
after the frænum has been removed.  This can last for
several days.  Painkillers such as
Ibuprofen or
Paracetamol are very effective.  Obviously, the painkiller
you use is dependent on your medical history & the ease
with which the
frænectomy was carried out.

Swelling.  There will be swelling afterwards.  This can last
several days.  Avoidance in the first few hours post-op of
exercise or hot foods / drinks will decrease the degree of
swelling that can develop.

Stitches.  The frænectomy site will be closed with
stitches.  These are dissolvable and ‘fall out’ within 10 – 14

Limited Mouth Opening.  Often the chewing muscles and
the jaw joints are sore after the procedure so that mouth
opening can be limited for the next few days.

Conscious Use of Tongue.  Don’t automatically assume
that once the tongue tie has been released, you’ll be
automatically able to stick your tongue out.  You will have
been used to the tongue being limited in its movements for
a number of years so to fully use the ‘released’ tongue, a
conscious effort will have to be made to use it.

Floor of the Mouth Complications.  This may have an
effect on the salivary ducts in the region of the floor of the
mouth in that the stitches may restrict the outward flow of
saliva and this can lead to ballooning up of the floor of the
mouth.  If this is the case, get back in contact with the
OMFS department / Oral Surgeon post-haste.

Repetition of Frænectomy.  Sometimes, the degree of
tongue movement is not as great as expected and may
mean that the
frænectomy needs to be done again.

Closure of Spaced Teeth.  Having an upper frænectomy
will not necessarily by itself, produce the closure of the
space.  It is often an adjunct to the Orthodontic closing of
the space.

Exposed, Raw Areas.  If the upper frænum has been
removed, there may be initially, an area in the midline
where the gums can not be approximated; this produces a
raw area that can take awhile to heal.

Gum Recession.  When the upper frænum is removed, it
is possible that the gums around the upper central incisors
may recede.

Level of ‘Lip Line’.  Once the frænum has been removed,
the upper lip is freed and can ‘ride up’ higher displaying
more teeth and gums (that is, showing a higher lip line).

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Last Updated 9th November 2010