What are the other Names for this Condition? (Also known as/Synonyms)

• Aberrant Frenal Attachment
• Aberrant Frenum
• Abnormal Frenulum

What is Abnormal Frenal Attachment? (Definition/Background Information)

• The frenum or frenulum is a fibro-muscular membranous tissue that is normally present at various body sites including the following (below). It has an important role to play at these locations
  • Below the tongue (it is called lingual frenulum)
  • Below the lip (labial frenulum)
  • Inside the cheek (buccal frenulum)
  • Involving the male genitalia (frenulum of prepuce of penis)
  • Involving the female genitalia (frenulum of labia minora)
  • Other locations include the brain and the digestive tract
• However, an Abnormal Frenal Attachment is a congenital condition wherein the presence of an abnormally-formed frenulum restricts the movement of the body part it is attached to, or prevents it from performing its full function
• In the oral cavity, an Abnormal Frenal Attachment can result in feeding difficulties in infants, speaking difficulties, poor oral hygiene. Within the genitalia, it can cause painful or uncomfortable sex. Nevertheless, in most cases, the condition is correctable through surgery, when required
• Abnormal Frenal Attachment occurs due to an abnormal growth during fetal development. The severity of the condition can vary from one individual to another. In some cases, only a mild restriction is observed; whereas, in some other cases, the presence of a prominent frenulum may severely hamper movement or normal function
• The treatment measures for Abnormal Frenal Attachment include a frenectomy or frenotomy (surgery to rectify the abnormal frenulum). With adequate treatment, the prognosis is typically good in a majority of individuals

Who gets Abnormal Frenal Attachment? (Age and Sex Distribution)

• The incidence of Abnormal Frenal Attachment depends on the specific location it involves
• Most cases are diagnosed in infants and young children; although, it may be diagnosed at a later stage in adults too
• Both males and females are affected, but the condition is more frequently observed in males, when the mouth is involved
• Racial, ethnic, or geographical predominance is not observed

What are the Risk Factors for Abnormal Frenal Attachment? (Predisposing Factors)

The risk factors for Abnormal Frenal Attachment may include:

• A positive family history of the condition may be a risk factor
• Male children have a higher risk than female children
• In some cases, an associated genetic disorder may be present

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Abnormal Frenal Attachment? (Etiology)

• The exact cause of development of Abnormal Frenal Attachment is not well-established
• However, it is believed that the growth of the frenulum does not take place normally during fetal development, resulting in the condition

What are the Signs and Symptoms of Abnormal Frenal Attachment?            

The signs and symptoms of Abnormal Frenal Attachment depend on the specific body site it involves.

Abnormal Frenal Attachment in the oral cavity may cause:

• Chewing and eating difficulties
• Speaking difficulties
• Difficulty in breastfeeding
• Difficulties in brushing and flossing one’s teeth
• Bad breath

Abnormal Frenal Attachment in the genital region may cause:

• Painful sex
• Discomfort during sexual activities

The symptoms vary according to severity of the abnormal tissue growth. Excessive (or absent) frenulum growth can cause more severe symptoms than milder cases of Abnormal Frenal Attachment.

How is Abnormal Frenal Attachment Diagnosed?

Abnormal Frenal Attachment is diagnosed using the following methods:

• A complete physical examination (including examination of the specific body region, such as mouth or genitalia). In many cases, a visual exam is sufficient to establish a diagnosis
• Assessment of medical history including the presence of any underlying conditions, family history, etc.
• Ultrasound imaging studies of the affected region

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Abnormal Frenal Attachment?

Complications due to Abnormal Frenal Attachment depend on the body site involved and may include:

• Breastfeeding difficulties causing increased susceptibility to infections
• Dental decay and formation of other dental health conditions such as gingivitis and periodontal disease
• Difficulty or severe discomfort while having sex
• Emotional stress and reduced self-esteem
• Cosmetic issues
• Complications that result from the surgical procedures used to treat the condition

How is Abnormal Frenal Attachment Treated?

The treatment for Abnormal Frenal Attachment may include:

• A ‘wait and watch’ approach may be undertaken by the healthcare provider for mild cases
• A surgical correction of the condition, called frenectomy or frenotomy, may be performed for severe cases. Any of the following techniques may be employed:
  • Conventional scalpel method (surgical knife method)
  • Soft-tissue laser surgery
  • Electrocautery or thermal cautery

It has been noted than in some rare cases, the condition resolves on its own.

How can Abnormal Frenal Attachment be Prevented?

Currently, there are no available measures to prevent Abnormal Frenal Attachment. However, if it is associated with a genetic disorder, then the following may be considered:

• Genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing of the fetus during pregnancy) may help in understanding the risks better during pregnancy
• If there is a family history of the condition, then genetic counseling will help assess risks, before planning for a child
• Active research is currently being performed to explore the possibilities for treatment and prevention of inherited and acquired genetic disorders

What is the Prognosis of Abnormal Frenal Attachment? (Outcomes/Resolutions)

The prognosis of Abnormal Frenal Attachment is generally good with appropriate treatment (including surgery).

Additional and Relevant Useful Information for Abnormal Frenal Attachment:

• Tongue tie or ankyloglossia is a congenital condition wherein the frenulum at the base of the mouth below the tongue is abnormally small/short, thereby restricting movement of the tongue
• Lip tie is a congenital condition wherein the presence of an abnormal frenum, between the lip and front teeth mostly in the upper jaw, may result in pain, eating or speaking difficulties, or even cause the gums to recede