Acute Speech Impediment due to Abnormal Labial Frenum in a 5 Year Old Girl: A Case Report

Abstract

Healthy teeth & gingival tissues are important for esthetic appearance & good functional ability of a person's face. Abnormal frenal attachment may lead to oro-facial problems. Abnormal lingual frenum (tongue-tie) which is commonly seen is a known cause for speech & masticatory impairment. This case report discusses a rare case of abnormal labial frenum which affected speech and mastication of a young child. 1 to provide stability to the upper lip. Abnormal labial frenum may lead to many problems such as dental decay on the upper front teeth, gaps (diastema) between the two teeth, orthodontic or periodontal problems later in the child's oral development, poor lip mobility or function, especially during smiling and speaking; certain sounds, like 's' cannot be 2 pronounced properly. In addition, a number of systemic conditions are associated with an abnormal frenum. Two potentially fatal conditions associated with a hyperplastic frenum are hypoplastic left heart syndrome and Ellis-Van 3-5 Creveld syndrome. In contrast, hypoplastic or absent frena may be manifestations of infantile hypertrophic pyloric 6,7 stenosis, and Saldino-Noonan syndrome (a fatal chondrodystrophy associated with multiple osseous and 8 visceral abnormalities). Benign associations include orodigitofacial dystosis-in which hypertrophied labial, lingual, and lateral frenula produce clefts of the upper lip-and 9 various other oral mucosal abnormalities. However, hyperplastic frena are often isolated anomalies and may be familial. In this particular case child was having difficulty in mastication & speech. Case report Similar presence of thick labial frenum was not seen in either of the parent or the sibling or any of the close relatives. There was no history of increase in size of the frenum. The patient had dull moderate pain. Pain was felt between the upper lip and anterior teeth (labial mucosa) during eating, blowing and during pronunciation of certain letters like 'p', 'f, 's' etc. Patient had a discoloured left upper central incisor (history of trauma was present). Pulpectomy was done for the same around one year back. The tooth was asymptomatic. After routine blood investigations, which were normal; surgery was performed under local anesthesia (Fig. 3) using surgical blade no 11. The surgical procedure was done in which the frenum was resected and the residual labial soft tissues were closed primarily using non absorbable 3-0 black breaded silk sutures, whereas the wound on the labial gingival was left open for secondary healing (Fig. 4). Post operatively the patient was prescribed a course of antibiotics and analgesics. After seven days the sutures were removed. Adequate wound healing was seen (Fig. 5). Follow up for the patient was done at 15th day, one month, three months and six months interval post surgery. Outcome of the surgery was satisfactory with remarkable improvement in speech and mastication.