Frenula in the Oral Cavity – Impact on Craniofacial Development and Respiratory Disorders. Literature Review.
DOI:
https://doi.org/10.12775/QS.2026.53.69916Keywords
oral frenulum; ankyloglossia; labial frenulum; craniofacial development; stomatognathic system; frenectomyAbstract
Frenula of the oral cavity are small anatomical structures that play a significant role in the proper functioning of the stomatognathic system. Despite their relatively simple morphology, abnormalities in the structure, length, or attachment of oral frenula may influence feeding, speech, oral hygiene, occlusion, and craniofacial development. Disorders related to labial, lingual, and buccal frenula are observed in patients of all ages and may require interdisciplinary management involving dentistry, orthodontics, speech therapy, and oral surgery. Due to the wide spectrum of clinical consequences associated with abnormal frenula, a thorough understanding of their anatomy, classification, and clinical significance is essential.
References
1. Iwanaga J, Takeuchi N, Oskouian R J, et al. (June 29, 2017) Clinical Anatomy of the Frenulum of the Oral Vestibule. Cureus 9(6): e1410. DOI 10.7759/cureus.1410
2. Edwards JG. A clinical study: the diastema, the frenum, the frenectomy. Oral Health.
1977;67:51-62. DOI: 10.1016/0002-9416(77)90001-x
3. Scarano A., Lorusso F., Inchingolo F., Postiglione F., Petrini M. The Effects of Erbium-Doped Yttrium Aluminum Garnet Laser (Er: YAG) Irradiation on Sandblasted and Acid-Etched (SLA) Titanium, an In Vitro Study. Materials. 2020;13:4174. DOI: 10.3390/ma13184174.
4. Chirurgia stomatologiczna, Chiapasco M, wyd. 3, Urban&Partner, Wrocław 2020
5.Zarys współczesnej ortodoncji, Karłowska I, wyd. IV, PZWL, Warszawa 2021
6. Chloe Santa Maria, MBBS, MPH1,2, Janelle Aby, MD1,3, Mai Thy Truong, MD1, Yogita Thakur, DDS, MS1, Sharon Rea, BA, IBCLC3, Anna Messner, MD1: The Superior Labial Frenulub in Newborns: What Is Normal? DOI 10.11 77 / 2333794 X 17718896
7. Tadros S, Ben-Do, T, Ó Catháin É, Anglin C, & April MM. (2022). Association between superior labial frenum and maxillary midline diastema — a systematic review. International Journal of Pediatric Otorhinolaryngology, 156, 111063. DOI: 10.1016/j.ijporl.2022.111063
8. Sękowska A, & Chałas R. (2017). Diastema size and type of upper lip midline frenulum attachment. Folia Morphologica, 76(3), 501–505. DOI: 10.5603/FM.a2016.0079
9. Mirko P, Miroslav S, Lubor M. Significance of the Labial Frenum Attachment in Periodontal Disease in Man. Part I. Classification and Epidemiology of the Labial Frenum Attachment. Periodontol. 1974;45:891–894. DOI: 10.1902/jop.1974.45.12.891.
10. Rahnama M. (Ed.). (2018). Oral and Maxillofacial Surgery. Vol. 1. Warsaw: PZWL Medical Publishing.
11. Górska R. (Ed.). (2019). Periodontology. Warsaw: PZWL Medical Publishing.
12. Protetyka stomatologiczna - protezy całkowite, red. L. Hupfaufa, Płonka B, Urban&Partner, Wrocław 1994
13. Kobylińska A, Studnicki M, Olczak-Kowalczyk D. (2021). Prevalence of labial and lingual frena attachments in pediatric patients in Warsaw agglomeration – a cross-sectional study. Nowa Stomatologia, 26(4), 129–141. DOI: 10.25121/NS.2021.26.4.129
14. Kotlow LA. Diagnosing and understanding the maxillary lip-tie (superior labial, the maxillary labial frenum) as it relates to breastfeeding. J Hum Lact. 2013;29:458-464. DOI: 10.1177/0890334413491325
15. Priyanka M, Sruthi R, Ramakrishnan T, Emmadi P, Ambalavanan N. An overview of frenal attachments. J Indian Soc Periodontol. 2013;17(1):12–5. DOI: 10.4103/0972-124X.107467
16. Jindal V, Kaur R, Goel A, Mahajan A, Mahajan N, Mahajan A. Variations in the frenal morphology in the diverse population: a clinical study. J Indian Soc Periodontol. 2016;20(3):320–3. DOI: 10.4103/0972-124X.182598
17. Livingstone D, Murthy V, Baliah J, Pillai A. Double frenum weds fusion: a rare wedlock? BMJ Case Rep. 2015;2015:bcr2014204502. DOI: 10.1136/bcr-2014-204502
18. Bagga S, Bhat KM, Bhat GS, Thomas BS. Esthetic management of the upper labial frenum: a novel frenectomy technique. Quintessence Int. 2006 Nov-Dec;37(10):819–23
19. Górska R. Diagnostyka i leczenie chorób błony śluzowej jamy ust- nej. Med Tour Press 2011
20. Sfasciotti GL, Zara F, Vozza I, Carocci V, Ierardo G, Polimeni A. Di- ode versus CO2 laser therapy in the treatment of high labial frenulum attachment: a pilot randomized, double-blinded clinical trial. Int J Environ Res Public Health 2020; 17: 7708. DOI: 10.3390/ijerph17217708
21. Łasiński W, Anatomia głowy dla stomatologów, PZWL, wyd. VI, Warszawa 1993r.
22. Martinelli RLC, Marchesan IQ, Berretin-Felix G. Longitudinal study of the anatomical characteristics of the lingual frenulum and comparison to literature. Rev CEFAC 2014; 16: 1202–1207. DOI: 10.1590/1982-021620149913
23. Martinelli RLC, Marchesan IQ, Gusmão RJ, et al. Histological characteristics of altered human lingual frenulum. Int J Pediatr Child Health 2014; 2: 5–9. DOI: 10.12974/2311-8687.2014.02.01.2
24. Yoon A, Zaghi S, Weitzman R, et al. Toward a functional definition of ankyloglossia: validating current grading scales for lingual frenulum length and tongue mobility in 1052 subjects. Sleep Breath. 2017;21(3):767–75. DOI: 10.1007/s11325-016-1452-7
25. Amir LH, James JP, Beatty, J. Review of tongue-tie release at a tertiary maternity hospital. J. Paediatr. Child Health 2005, 41, 243–245. DOI: 10.1111/j.1440-1754.2005.00603.x
26. Segal ML, Stephenson R, Dawes, M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia: Methodologic review—PubMed. Can. Fam Physician 2007, 53, 1027–1033.
27. Boutsi EA, Tatakis DN. Maxillary labial frenum attachment in children. Int. J. Paediatr. Dent. 2011, 21, 284–288. DOI: 10.1111/j.1365-263X.2011.01121.x
28. Jamilian A, Fattahi FH, Kootanayi NG. Ankyloglossia and tongue mobility. Eur. Arch. Paediatr. Dent. 2014, 15, 33–35. DOI: 10.1007/s40368-013-0049-0
29. Cruz PV, Souza-Oliveira AC, Notaro SQ, et al. Prevalence of ankyloglossia according to different assess ment tools: a meta-analysis. JADA. 2022;153(11):1026 1040.e31. DOI: 10.1016/j.adaj.2022.07.011
30. Ruffoli R, Giambelluca MA, Scavuzzo MC, Bonfigli D, Cristofani R, Gabriele M, Giuca MR, Giannessi, F. Ankyloglossia: A morphofunctional investigation in children. Oral Dis. 2005, 11, 170–174. DOI: 10.1111/j.1601-0825.2005.01108.x
31. Bai, P.M.; Vaz, A.C. Ankyloglossia among children of regular and special schools in Karnataka, India: A prevalence study. J. Clin. Diagnostic Res. 2014, 8, 36–38. DOI: 10.7860/JCDR/2014/8267.4485
32. Christian Guilleminault, Shehlanoor Huseni and Lauren Lo, A frequent phenotype for paediatric sleep apnoea: short lingual frenulum, Stanford University Sleep Medicine Division, Redwood City, CA, USA., 2016. DOI: 10.1183/23120541.00043-2016
33. Walker RD, Messing S, Rosen-Carole C, McKenna Benoit M. Defining tip frenulum length for ankyloglossia and its impact on breastfeeding: a prospective cohort study. Breastfeed Med. 2018;13(3):204–10. DOI: 10.1089/bfm.2017.0116
34. Messner AH, Lalakea ML, Aby J, et al. Ankyloglossia: incidence and associated feeding difficulties. Arch Otolaryngol Head Neck Surg 2000; 126: 36–39. DOI: 10.1001/archotol.126.1.36
35. Ricke LA, Baker NJ, Madlon-Kay DJ, et al. Newborn tongue tie: prevalence and effect on breast-feeding. JAm Board Fam Pract 2005; 18: 1–7. DOI: 10.3122/jabfm.18.1.1
36. Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005; 41: 246–250. DOI: 10.1111/j.1440-1754.2005.00604.x
37. García Pola MJ, González García M, García Martín JM, et al. A study of pathology associated with short lingual frenum. ASDC J Dent Child 2002; 69: 59–62.
38/34. Messner A, Lalakea L, Aby J, Macmahon J, Bair E. Ankyloglossia: incidence and associated breast feeding difficulties. Arch Otolaryngol Head Neck Surg. 2000;126:36-39. DOI: 10.1001/archotol.126.1.36
39. Vaz A, Bai P. Lingual frenulum and malocclusion: an overlooked tissue or a minor issue. Indian J Dent Res. 2015;26(5):488–92. DOI: 10.4103/0970-9290.172044
40. Colombari, G.C.; Mariusso, M.R.; Ercolin, L.T.; Mazzoleni, S.; Stellini, E.; Ludovichetti, F.S. Relationship between Breastfeeding Difficulties, Ankyloglossia, and Frenotomy: A Literature Review. J. Contemp. Dent. Pract. 2021, 22, 452–461.
41. Zaghi S, Valcu-Pinkerton S, Jabara M, Norouz-Knutsen L, Govardhan C, Moeller J, Sinkus V, Thorsen RS, Downing V, Camacho M, et al. Lingual frenuloplasty with myofunctional therapy: Exploring safety and efficacy in 348 cases. Laryngoscope Investig. Otolaryngol. 2019, 4, 489–496. DOI: 10.1002/lio2.297
42. Baxter R, Merkel-Walsh R, Baxter BS, Lashley A, Rendell NR. Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study. Clin. Pediatr. 2020, 59, 885–892. DOI: 10.1177/0009922820928055
43. Fioravanti M, Zara F, Vozza I, Polimeni A, Sfasciotti GL. The Efficacy of Lingual Laser Frenectomy in Pediatric OSAS: A Randomized Double-Blinded and Controlled Clinical Study. Int. J. Environ. Res. Public Health 2021, 18, 6112. DOI: 10.3390/ijerph18116112
44/32. Guilleminault C, Huseni S, Lo L. A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Res. 2016;2(3):00043–2016. DOI: 10.1183/23120541.00043-2016
45/37. García Pola MJ, González García M, García Martín JM, et al. A study of pathology associated with short lingual frenum. ASDC J Dent Child 2002; 69: 59–62.
46. ASDC J Dent Child 2002; 69: 59–62. Lalakea L, Messner AH. Ankyloglossia: the adolescent and adult perspective. Otolaryngol Head Neck Surg 2003; 128: 746–752. DOI: 10.1016/S0194-59980300258-4
47. Marchesan IQ. Lingual frenulum: classification and speech interference. Int J Orofacial Myology 2004; 30: 31–38.
48. Suter VG, Bornstein MM. Ankyloglossia: Facts and Myths in Diagnosis and Treatment. J. Periodontol. 2009, 80, 1204–1219. DOI: 10.1902/jop.2009.090086
49. Messner AH, Lalakea ML. The effect of ankyloglossia on speech in children. Otolaryngol.-Head Neck Surg. 2002, 127, 539–545. DOI: 10.1067/mhn.2002.129731
50. Defabianis P. Ankyloglossia and its influence on maxillary and mandibular development. (A seven year follow-up case report). Funct Orthod 2000; 17: 25–33.
51. Calvo-Henríquez C, Neves SM, Branco AM, et al. Relationship between short lingual frenulum and malocclusion: a multicentre study. Acta Otorrinolaringol Esp (Engl ed). 2022;73(3):177-183. DOI: 10.1016/j.otoeng.2021.01.003
52. Jang SJ, Cha BK, Ngan P, Choi DS, Lee SK, Jang I. Relationship between the lingual frenulum and craniofacial morphology in adults. Am J Orthod Dentofacial Orthop. 2011;139(4 Suppl):e361–7. DOI: 10.1016/j.ajodo.2009.07.017
53. Kupietzky A, Botzer E. Ankyloglossia in the infant and young child: Clinical suggestions for diagnosis and management - PubMed. Padiatr. Dent. 2005, 27, 40–46.
54. Yoon A, Zaghi S, Weitzman R, Ha S, Law CS, Guilleminault C, Liu SY. Toward a functional definition of ankyloglossia: Validating current grading scales for lingual frenulum length and tongue mobility in 1052 subjects. Sleep Breath 2017, 21, 767–775.
55. Felemban R, Mawardi H. Congenital absence of lingual frenum in a non syndromic patient: a case report. J Med Case Rep. 2019;13:56. DOI: 10.1186/s13256-018-1966-7
56. Machet L, Hüttenberger B, Georgesco G, et al. Absence of inferior labial and lingual frenula in Ehlers-Danlos syndrome. Am J Clin Dermatol. 2010;11(4): 269–73. DOI: 10.2165/11530090-000000000-00000
57. Mintz SM, Siegel MA, Seider PJ. An overview of oral frena and their association with multiple syndromic and nonsyndromic conditions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(3):321–4. DOI: 10.1016/j.tripleo.2004.08.008
58. Toker H, Ozdemir H: Gingival recession: epidemiology and risk indicators in a university dental hospital in Turkey. Int J Dent Hyg. 2009, 7:115–120. DOI: 10.1111/j.1601-5037.2008.00348.x
59. Boucher CO: Complete denture impressions based upon the anatomy of the mouth. JADA. 1944, 31:1174–1181.
60. Boucher CO: A critical analysis of mid-century impression techniques for full dentures . J Prosthet Dent. 1951, 1:472–491. DOI: 10.1016/0022-3913(51)90032-7
61. Al Jabbari YS. Frenectomy for improvement of a problematic con- ventional maxillary complete denture in an elderly patient: a case report. J Adv Prosthodont. 2011;3(4):236-239. DOI: 10.4047/jap.2011.3.4.236
62. Frenum position and vestibule depth in relation to gingival health. Gottsegen R. Oral Surg Oral Med Oral Pathol. 1954;7:1069–1078. doi: 10.1016/0030-4220(54)90216-9.
63. Frenulum labii superioris. Anatomical variations and abnormalities (Article in Danish) Sewerin I. Tandlaegebladet. 1969;73:443–456.
64. Prevalence of variations and anomalies of the upper labial frenum. Sewerin I. Acta Odontol Scand. 1971;29:487–496. DOI: 10.3109/00016357109026535.
65. Histologic features of the superior labial frenum. Henry SW, Levin MP, Tsaknis PJ. J Periodontol. 1976;47:25–28. DOI: 10.1902/jop.1976.47.1.25.
66. The diastema, the frenum, the frenectomy: a clinical study. American journal of orthodontics. Edwards JG. Am J Orthod. 1977;71:489–508. DOI: 10.1016/0002-9416(77)90001-x.
67. Frenectomy: a review with the reports of surgical techniques. Devishree Devishree, Gujjari SK, Shubhashini PV. JCDR. 2012;6:1587–1592. DOI: 10.7860/JCDR/2012/4089.2572
68. Baxter R, Merkel-Walsh R, Lahey L, Knutsen C, Zaghi S. (2023). The buccal frenum: Trends in diagnosis and indications for treatment of buccal-ties among 466 healthcare professionals. Journal of Oral Rehabilitation, 51(6), 1–11. DOI: 10.1111/joor.13609
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