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Clinical Summary

A frenulum is a mucosal fold that connects to mobile tissue and secures it in place. The oral frenula include the frenulum linguae (connects underside of the tongue to base on mouth), frenulum labii superioris (connects upper lip to the gingiva), and the frenulum labii inferioris (connects upper lip to the gingiva). Tearing of the frenula can be caused by direct trauma to the area. Like most oral injures, there can be a significant amount of bleeding, but it generally stops spontaneously or with direct pressure. Frenulum tears can be a result of but are not pathognomonic for nonaccidental trauma. Mechanisms of injury include forceful feeding (“bottle jamming”) or pacifier insertion, gripping or stretching lip, or direct blow.

Management and Disposition

Management is generally reassurance, and tears rarely require primary closure. If there is continued bleeding, hold pressure to the outside of the lip until bleeding stops. Advise parents to avoid pulling the lip open to check for healing as it can lead to further trauma. Rarely, primary closure is required. If the tear extends further into the gingiva or is a portion of a larger oral injury, consider closure with absorbable sutures. Frenulum tears and other intraoral injuries are seen in a significant number of nonaccidental trauma cases. If the development of the infant and the history are not consistent with the injury, be sure to complete a full skin assessment to look for other injuries and have a high index of suspicion for nonaccidental trauma.

Pearls

  1. A frenulum tear can be caused by “bottle jamming” from force feeding and can be a sign of nonaccidental trauma. Be sure to have a high index of suspicion in nonambulatory infants.

  2. An isolated frenulum tear can be managed conservatively and rarely needs primary closure.

FIGURE 14.128

Frenulum Tear. This ambulatory child fell, causing the frenulum to tear. An associated chin abrasion is present. Feasible history in an ambulatory child makes nonaccidental trauma unlikely. (Photo contributor: Kevin J. Knoop, MD, MS.)

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