Management of Upper Frenulum Tear
For a tear of the upper frenulum, surgical repair using the "pull and burn" method is recommended as the most effective treatment approach to prevent complications and ensure proper healing.
Initial Assessment
- Evaluate the extent of the tear
- Check for active bleeding
- Assess for signs of infection
- Determine if the tear is partial or complete
Treatment Options
For Minor Tears with Minimal Bleeding:
- Clean the area with sterile saline solution
- Apply gentle pressure to control bleeding
- Consider application of topical anesthetic (EMLA cream) for pain relief
- Monitor for healing without surgical intervention
For Moderate to Severe Tears:
"Pull and Burn" Method (Preferred Approach) 1, 2:
- Apply EMLA cream for 15-20 minutes to achieve local anesthesia
- Identify the point of maximum tension
- Use diathermy to cut at this point
- Apply gentle but firm retraction on the area to create a controlled vertical tear
- Seal minor bleeding with diathermy
- No sutures are typically required (only 1.6% of cases needed sutures)
Surgical Repair with Sutures (Alternative) 3:
- May be necessary for very thick or wide frenulum tears
- Requires careful technique to avoid damaging the frenular artery
- Higher risk of complications including meatal stenosis
Post-Procedure Care
- Maintain good personal hygiene
- No need for local antiseptics or antibiotics unless signs of infection develop
- Avoid activities that could cause further trauma to the area
- Follow-up evaluation at 2-3 months to assess healing
Potential Complications to Monitor
- Bleeding (most common complication)
- Infection
- Meatal stenosis (particularly with suture techniques that damage frenular vessels) 2
- Scarring with potential functional impairment
Special Considerations
- In neonates and young children, frenulum procedures should only be performed by trained medical professionals, as improper technique can lead to severe complications including life-threatening bleeding 4
- There is insufficient evidence linking torn frenulum in children to non-accidental injury 5
Treatment Efficacy
The "pull and burn" method has demonstrated excellent outcomes:
- Preserves the frenular artery
- Reduces risk of meatal stenosis
- Provides excellent functional and cosmetic results
- Reported success rate of 99.6% with only 0.4% requiring additional treatment 2
This suture-free approach respects the anatomy of the area and has been shown to be safe and effective in multiple studies, with minimal complications when performed correctly.