Abstract
Lingual frenotomy has become an increasingly common surgical procedure, performed for a broad range of indications from birth through adulthood. This study utilizes histology to define the structure and tissue composition of the lingual frenulum and floor of mouth (FOM) fascia. En bloc specimens of anterior tongue, lingual frenulum, and FOM tissues were harvested from ten embalmed adult cadavers. An additional three fresh tissue cadaveric specimens were frozen with the tongue supported in an elevated position, to enable harvesting and paraffin embedding of the elevated lingual frenulum as a discrete specimen. All 13 specimens were prepared as ten-micron coronal sections using stains to determine the general morphology of the lingual frenulum, its relationship to neighbouring structures (Mason's Trichrome), presence of elastin fibers (Verhoeff-van Gieson), and collagen typing (Picrosirius Red). Our results have shown a submucosal layer of fascia spanning horizontally across the FOM was present in all specimens, with variability in fascial thickness and histologic composition. This FOM fascia suspends the sublingual glands, vessels, and genioglossus from its deep surface. The elevated lingual frenulum is formed by a central fold of this FOM fascia together with the overlying oral mucosa with variability in fascial thickness and composition. With tongue elevation, the fascia mobilizes to a variable extent into the fold forming the frenulum, providing a structural explanation for the individual variability in lingual frenulum morphology seen in clinical practice.
Highlights
Lingual frenotomy has become an increasingly common surgical procedure, performed for a broad range of indications from birth through adulthood. is study utilizes histology to define the structure and tissue composition of the lingual frenulum and floor of mouth (FOM) fascia
Our results have shown a submucosal layer of fascia spanning horizontally across the FOM was present in all specimens, with variability in fascial thickness and histologic composition. is FOM fascia suspends the sublingual glands, vessels, and genioglossus from its deep surface. e elevated lingual frenulum is formed by a central fold of this FOM fascia together with the overlying oral mucosa with variability in fascial thickness and composition
Our findings were consistent with the description by Fuchs, with the connective tissue fibers forming a scaffold-like framework [5], but we conclude that the histotopographic structure of the frenulum is definitely not a cord or band, with no discrete midsagittal connective tissue structure identified in any specimen
Summary
Lingual frenotomy has become an increasingly common surgical procedure, performed for a broad range of indications from birth through adulthood. is study utilizes histology to define the structure and tissue composition of the lingual frenulum and floor of mouth (FOM) fascia. The understanding of lingual frenulum structure has been comprehensively revised following two studies using microdissection of fresh tissue cadavers [3, 4] showing that the lingual frenulum is formed by a midsagittal fold in a layer of fascia that spans across the floor of mouth. Connective tissue fibers beneath the epithelium in the region of the lingual frenulum were described as crossing diagonally to the longitudinal axis of the frenulum, forming a scaffold-like framework. Despite these findings, Fuchs described the frenulum structure as a “band.” is discrepancy in interpretation was possibly due to their study assessing. Variability in the abundance and location of elastin fibers was noted. e location, size, and orientation of the biopsied tissue were not stated, and no conclusions were able to be drawn regarding frenulum structure or morphology
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