Tongue-Tie and Lip-Tie Surgery in Ukraine

Three frenula in the mouth most often cause problems: the tongue frenulum, a fold of mucosa between the floor of the mouth and the underside of the tongue; the upper lip frenulum, a band running from the vestibule of the mouth to the gum above the central incisors; and the lower lip frenulum, arranged in the same way below. Normally each is elastic and does not restrict movement. Problems arise when the fold is short, thick or attached too close to the gum margin or the tip of the tongue.

A short tongue frenulum, known as ankyloglossia or tongue-tie, restricts lifting the tongue to the palate and pushing it forward. In a baby this makes it hard to latch on and stay latched: feeds drag on, there is a clicking sound, the mother has pain and cracked nipples, and the baby gains weight slowly. In a preschool or school-age child the same restriction shows up differently: the tongue cannot reach the ridge behind the upper teeth, so sounds made with the tip of the tongue are affected, above all [r], [l] and sounds such as sh and ch.

The upper lip frenulum causes different problems. When it is attached low and merges into the papilla between the teeth, a gap remains between the central incisors, a diastema, which tends to reopen after the teeth have been brought together orthodontically. The lower lip frenulum pulls on the gum margin with every movement of the lip, and over the years this leads to recession, the exposure of the necks of the lower incisors. In adults the same fold can also interfere with dentures: it keeps dislodging the edge of a removable denture.

It is just as important to know who does not need surgery. A frenulum that looks short is not in itself a reason to operate: surgery treats impaired function, not anatomy. If a baby is gaining weight well and the mother has no pain, no procedure is needed even if a restriction is visible. If a child can pronounce all sounds, the frenulum is not cut "just in case" before school starts. And if a diastema has formed because of a supernumerary tooth between the incisors or a mismatch in tooth sizes, cutting the frenulum will not close it.

MediUkraine is a service that finds and coordinates treatment; it is not a clinic. We find the clinic and a doctor with the right specialism, agree the date of your visit and support you throughout, including if you are travelling from abroad. Whether surgery is needed, and which technique to use, is decided by the doctor after an in-person examination.

The choice of technique depends on which frenulum is restricting movement, how thick it is and where it is attached. The doctor does not judge this by eye: they ask the patient to lift the tongue to the palate with the mouth open, measure the distance between the incisors in that position, and see whether the tongue can be pushed forward and whether it reaches the upper lip; with a lip frenulum, they pull the lip back and check whether the papilla between the teeth blanches and whether the gum margin shifts. These simple tests show whether a procedure is needed and how extensive it should be.

Frenotomy is the simplest of the techniques: the frenulum is cut across at one point and the mucosa separates, freeing movement. In babies it is done with sterile scissors in a few seconds, usually without sutures; bleeding is minimal, and the baby is put to the breast immediately after the procedure. The reasons here are purely functional: pain for the mother, cracked nipples, long and ineffective feeds, poor weight gain, slipping off the breast, clicking while sucking. Studies show that frenotomy fairly reliably reduces the mother's pain within the first few days, whereas evidence on how long breastfeeding continues is weaker and more mixed. That is why the procedure is done only when there is a genuine feeding problem that correcting the latch has not solved.

In children over a year old and in adults the same tongue frenulum is operated on for other reasons: limited lifting of the tongue to the palate, which affects sounds made with the tip of the tongue; tension on the gum of the lower incisors with recession; difficulty licking the lips and cleaning the side teeth. It is important to understand the limits of surgery here. The incision restores the tongue's mobility but does not teach the sound: the articulation pattern has already formed and has to be retrained with a speech therapist. Surgery alone does not correct speech, and this is the most common disappointment for parents who expected a change within a week.

Frenectomy is an excision: the frenulum is removed together with the fibrous tissue that merges into the papilla or the periosteum, and the wound is sutured. It is chosen when the fold is thick, dense and has a wide base. Frenuloplasty is a general name for techniques in which the frenulum is not simply removed but reconstructed. The best known of them is Z-plasty: two opposing triangular flaps are cut from the edges of the wound, swapped over and sutured, so that the scar line runs in a zigzag rather than along the direction of tension. V-Y plasty with flap advancement is also used when the mucosa of the vestibule needs to be lengthened.

Broadly, the choice works like this. A thin frenulum with a narrow attachment, especially in a baby: frenotomy. A thick, dense tongue frenulum in a child or adult, particularly after an unsuccessful previous incision: Z-plasty, because it distributes tension and reduces the likelihood of the scar pulling the tissue tight again. An upper lip frenulum that merges between the incisors: frenectomy, with the band excised right down to the space between the teeth, otherwise the remaining tissue will hold the gap open.

With the upper lip frenulum, the main question is timing rather than technique. The classic sequence is: first the orthodontist brings the central incisors together, and only then, when the gap is almost closed, is the frenulum excised and the teeth held in place with a retainer. If it is done the other way round, the scar between the incisors can prevent them from coming together. That is why surgery for a diastema is usually planned after the permanent canines have come through, not at preschool age, and is agreed with the orthodontist as part of their plan.

The lower lip frenulum and a shallow vestibule are the periodontist's area. Tissue tension with every movement of the lip pulls the gum margin away from the tooth, and over the years the necks of the lower incisors become exposed, sensitivity appears, and plaque builds up in an area that is hard to clean. In such cases either plasty of the frenulum itself is done or a wider procedure, vestibuloplasty, in which the vestibule is deepened across several teeth at once. The aim is to relieve the tension, not to "restore the gums": frenulum surgery does not restore lost gum tissue, which requires separate recession coverage procedures.

Scalpel, laser or electrocoagulator? This is perhaps the question patients ask most often. Laser incision causes less bleeding, often makes it possible to do without sutures and is convenient when working with a child who does not sit still in the chair. However, a laser wound heals by secondary intention and needs more thorough exercises, because the healing surface is wider. The scalpel technique with suturing gives a controlled scar line and is better suited to Z-plasty, where the whole point is to reconstruct the tissue. Comparative studies show no decisive advantage for any instrument in terms of the final result, so it makes sense to leave the choice to the surgeon, who uses the tools they know best every day.

In the vast majority of cases, local anaesthesia is used: first a topical gel on the mucosa, then an infiltration injection of anaesthetic into the operation area. Adults and school-age children tolerate this well. In babies frenotomy is often done without an injection, using a topical agent only, because the procedure itself is shorter than the preparation for it. General anaesthesia or sedation is considered separately for a small child who will not let the doctor work in their mouth, or when several procedures are combined; this requires an anaesthetist, a pre-assessment and separate consent.

Post-operative exercises are not an optional extra; they account for half of the result. The mucosa heals quickly, and if the new range of movement is not used every day, the scar pulls the tissue back to its original state. That is why, from the first days after the operation, stretching of the area under the tongue, lifting the tongue to the palate with the mouth open, clicking, holding and other movements are prescribed according to a plan given by the doctor or speech therapist. They are done several times a day for several weeks. Only a doctor can predict the result for an individual patient after an examination, but the pattern is consistent: where the exercises are done, the restriction returns less often.

The first few hours after the procedure are the most noticeable. While the anaesthetic is working there is no pain, but the tongue or lip is numb, so a child can easily bite it and should be watched. Eating is possible after about two hours, and for the first few days food should be cool, soft and bland.

A day later a whitish-grey coating appears on the wound. This is fibrin, a natural healing layer, not pus: there is no need to remove or scrape it off. Moderate swelling and pain when moving the tongue last 2–3 days and pass on their own; the doctor usually allows an ordinary painkiller in an age-appropriate dose.

Stitches, if used, are usually absorbable and dissolve within 7–14 days. Non-absorbable ones are removed at the follow-up examination at around day seven. The summary at the top of this page reflects the same timeframe: recovery of the mucosa takes 7–10 days, after which the wound no longer hurts and does not interfere with eating or speaking.

Some restrictions apply while the wound heals. Hot, spicy, sour and hard food irritates the wound; a sauna, swimming pool, heavy exertion and flying on the first day raise the risk of bleeding; drinking through a straw and vigorous rinsing can dislodge the clot. Brush your teeth as usual, avoiding the operation area, and treat the mouth with antiseptic as prescribed by the doctor.

When the result can be judged depends on the reason for surgery, and it is worth knowing this in advance. Mobility of the tongue or lip returns immediately after healing and is checked at the follow-up examination. With a baby, the mother usually notices a change in the latch within a few days. Speech, however, improves only as fast as the work with the speech therapist allows: establishing and automating sounds takes from a few months to half a year. A diastema is assessed within the timeline of orthodontic treatment, and the condition of the gums in recession after 3–6 months.

The follow-up examination is scheduled for day seven, and at it the doctor also checks that the exercises are being done correctly. You should seek help outside the schedule if bleeding continues for more than 15–20 minutes despite pressure, a temperature stays above 38 °C, swelling increases on the third day instead of going down, a foul smell appears, or the child refuses food and drink. After that, follow-up is handled by the specialist who referred the patient.