Treatment for Cheek Tie (Labial Frenulum)
The most appropriate treatment for a cheek tie (labial frenulum) is surgical release through either frenotomy or frenuloplasty, with the specific technique determined by the severity of the restriction and the patient's age.
Understanding Cheek Ties
- Cheek ties, also known as buccal-ties, are restrictive buccal frena that connect the mucosa of the cheek to the alveolar process 1
- All newborns have a labial frenulum, with approximately 83% having attachment at the gingival margins 2
- The diagnosis of problematic cheek ties requires both objective and subjective findings according to 94% of healthcare providers 1
Diagnostic Approach
Evaluation methods for cheek ties include:
The Kotlow classification system for labial frenulum has been used but shows poor intra- and interrater reliability (64% to 74% and 8%, respectively) 2
Treatment Options
Surgical Release
Frenotomy (simple cutting of the frenulum) is appropriate for mild to moderate restrictions 3
- Can be performed with no anesthesia or local anesthesia for minor cases
- Is safe and cost-effective, but approximately one-third of children may need re-operation when performed under local or no anesthesia 3
Frenuloplasty (more extensive surgical revision) is recommended for severe restrictions 3
- Often performed under general anesthesia for better results
- Only 0.6% of patients require re-operation when performed under general anesthesia 3
Timing of Intervention
- For infants with feeding difficulties, early intervention may be necessary 4
- For older children with speech or articulation problems (64% of cases), intervention can be performed when the issue is identified 3
- Other indications include restricted movement (18%) and lactation/nutrition problems (8%) 3
Post-Operative Care
- Approximately 76.8% of providers recommend post-operative stretches for optimal healing 1
- Keeping the surgical area clean and following specific wound care instructions is essential to prevent reattachment
Expected Outcomes
- About 84% of patients (or their guardians) report benefit from the surgical release of oral ties 3
- No significant postoperative complications have been reported with proper surgical technique 3
Important Considerations
- There is a lack of widely accepted classification, diagnostic and treatment guidelines for cheek ties 1
- The decision to treat should be based on symptomatic presentation rather than mere presence of the frenulum, as all newborns have some degree of labial frenulum attachment 2
- Adequate division of the frenulum is more important than the specific technique used (frenuloplasty vs. frenotomy) 3
Treatment Algorithm
- Assess for functional impairment (feeding difficulties, speech problems, restricted movement)
- If symptomatic:
- For mild restrictions: Consider frenotomy under local anesthesia
- For moderate to severe restrictions: Consider frenuloplasty under general anesthesia
- Implement post-operative stretching exercises to prevent reattachment
- Monitor for improvement in symptoms and assess need for any additional interventions