Lingual frenectomy

Lingual (Tongue) Frenectomy
Definition

Frenulum is a small section of webbing or fold of skin that constricts the movement of an organ. A Frenectomy (also called a frenulectomy or frenotomy) is the procedure of cutting or removing the designated frenulum. In this case a Lingual Frenectomy, as it is termed in the medical field, or a Tongue Frenectomy, as it is termed within the culture of body modification, is the process of cutting the webbing underneath the tongue. The specification of the terminology is to differentiate the frenulum of the tongue from the labial or penial frenulum.

Reasons

Reasons for receiving a lingual frenectomy vary greatly. For our purposes here we will divide the reasoning into three categories, for body modification, because of psychosis, or as a medical procedure. Body Modification

Performing a tongue frenectomy, or having a tongue frenectomy performed on you, follows the same reasoning as any other body modification practice. Such practices are explained by the Church of Body Modification on their website, “It is our belief that by practicing body modification and by engaging in rituals of body manipulation we strengthen the bond between mind, body, and soul and ensure that we live as spiritually complete and healthy individuals.”1

In “Mutilating the Body: Identity in Blood and Ink” Kim Hewitt supports this idea. In the second chapter she states. “Pain can prompt a loss of awareness of the self or ego, or in contradiction, actually mark one’s physical existence and result in awareness of one’s precise place in the universe.”2

Psychosis

While everyone that practices body modification is not suffering from some form of psychosis that is the case sometimes. On such occasions the terms is self mutilation, and the reasoning behind the actions is a good indicator. Armando R. Favazza states that, “(Acts of major self-mutilation) are not essential symptoms of any disorder but may appear as associated features. They are most commonly associated with psychosis and acute intoxication.”3 He then spends most of the second chapter of his book, “Bodies Under Siege: Self-mutilation and Body Modification in Culture and Psychiatry” giving examples of the types of reasons given for the self-mutilation. These examples range anywhere from trying to save the world, to being commanded to by a statue, to thinking it was a practical thing to do.4

Medical

Up to this point the reasons provided for the occurrence of lingual, or tongue, frenectomy have been general reasons that apply to all self mutilation or body modification practices. Lingual Frenectomy, though, is an actual procedure performed by doctors. When this is the case it is done for essential reasons and can be a great help in solving possible problems that could arise in later years for some individuals if they went without the procedure. The medical terminology for the diagnosis or which a lingual frenectomy needs to be performed is ankyloglossia. In lay man’s terms it means someone has a tongue-tie; this occurs when the frenulum expands over too large an area on the underside of the tongue, thus causing too much restriction to the movement of the tongue. First, a common misconception that has prevailed for centuries, and does still today even among doctors, is that ankyloglossia will impair one’s ability to speak. While, “There is virtually no evidence in the literature to establish a definite causal relationship between ankyloglossia and speech disorders,” Ann W. Kummer lists infant feeding, dental development and cosmetic and personal interaction as other areas that can be affected.5 Supporting the claim on infant feeding are numerous studies done to show that in infants with ankyloglossia having a lingual frenectomy will greatly help and that without it such consequences and early waning off of breast feeding and unnecessary discomfort for the woman can be seen. 6 & 7 Another reason a Lingual Frenectomy may be performed is with patients suffering from ADEL (ankyloglossia with deviation of the epiglottis and larynx). Essentially the ankyloglossia is so configured that it causes the individuals neck and head to be cricked forward and up slightly, but enough to cause problems. Symptoms ADEL range from snoring and lack of eye contact in children to insomnia and malaligned teeth in adults and more. Under these circumstances a lingual frenectomy is a little more extensive, but essentially the same cutting of the under-tongue webbing.

Procedures

The BME Encyclopedia, first off, suggests that you should never perform a lingual frenectomy on yourself. But, if you are going to, they suggest “rinsing with oral xylocaine and then sniping the frenulum with a small pair of surgical scissors.”8 hen performed by a doctor on infants with ankyloglossia the process is not much different. No anesthesia is used. The baby is held down, which generally the infants do not enjoy, the tongue is lifted and held in place to expose and fully stretch the frenulum, which is then cut with sharp, blunt-ended, sterile scissors. No bleeding is expected during this procedure. Promptly after finishing the procedure the baby is returned to their mother and in some cases breast feeding is suggested to begin promptly. When being performed on those with ADEL there are two different procedures, both requiring sedatives, the procedure used dependent upon the age of the person in question and the severity of the ADEL. If severity is medium to light and it is a baby less than four months old the procedure is fairly simple. After administering the sedative the mouth is held open with a gag and the tongue held in place with forceps. The frenulum is cut horizontally until the second layer of muscle can be seen and then the procedure is over. When the individual is older, or the severity of ADEL greater, the procedure becomes more complicated. To start a thick string is threaded through the middle of the tip of the tongue as the means by which the tongue will be held out of the way during the duration of the procedure. Here a vertical cut is made and again continues until the second layer of muscle can be seen. At this point blood vessels will be able to be seen, those should be tied off and then the second layer of muscle should be cut. If the ADEL is especially sever the last step will be repeated with the third layer of muscle. 9

Risks and Caution

The first common concern expressed by both the BME Encyclopedia and the practitioners performing the actual procedure is the issue of severing blood vessels. The procedure should involve no blood. Even in the case of one who has sever ADEL the blood should be minimal and the procedure has been established such that’ “bleeding is avoidable if the surgeon is careful.” 1 & 7 The BME Encyclopedia lists other issues that can occur from attempting this procedure on your own and highly recommends leaving it up to trained professionals.

Citations

1. The Church of Body Modification: http://uscobm.com/

2. Hewitt, Kim. Mutilating the Body: Identity in Blood and Ink. 1. Bowling Green, OH: Bowling Green state University Popular Press, 1997. Pp. 27-28

3. Favazza, Armando R. Bodies Under Siege: Self-mutilation and body Modification in Culture and Psychiatry. Baltimore, Maryland: The Johns Hopkins University Press, 1996. Pg. 234

4. Favazza, Armando R. Bodies Under Siege: Self-mutilation and body Modification in Culture and Psychiatry. Baltimore, Maryland: The Johns Hopkins University Press, 1996. Pp. 225-260

5. Kummer, Ann W. “Ankyloglossia: To Clip or Not to Clip? That’s the Question” The ASHA Leader. 27 Dec 2005 http://www.asha.org/about/publications/leader-online/archives/2005/051227/f051227a.htm

6. Amir, Lisa H, et al. “Review of Tongue-Tie Release at a Tertiary Maternity Hospital.” Journal Of Paediatrics And Child Health. May-June 2005, Vol. 41 (5-6), pp. 243-5.

7.Hogan, M. et al. Randomized, Controlled Trial of Division of Tongue-Tie in Infants With Feeding Problems. Journal Of Paediatrics And Child Health. 2005 May-Jun; Vol. 41 (5-6), pp. 246-50.

8. The Body Modification Encyclopedia http://wiki.bmezine.com/index.php/Tongue_Frenectomy

9. Mukai, S., Nitta, M. “Correction of the Glosso-Larynx and Resultant Positional Changes of the Hyoid Bone and Cranium.” Acta Oto-Laryngologica. 2002 Sep; Vol. 122 (6), pp. 644-50.