9/28/2023 0 Comments Baby lip quiver![]() Research examining the appearance of the frenulum based on age (during childhood, mean age 8.5 years) has found that frenulum attachment does seem to vary depending on age, with younger children having a more prominent frenulum (inserting onto the palatal surface of the papilla) and older children having a significantly less prominent frenulum (inserting on to, or above, the mucogingival junction). The natural history of this frenulum is also not well known. While ankyloglossia, a tight lingual frenulum, has been shown to affect breastfeeding, and improvement in latching onto the breast can be achieved with its release, 3, 4 there is no similar evidence for the superior labial frenula. The primary justification for these procedures is to facilitate and improve breastfeeding however, there is little evidence that certain appearances of the labial frenula have any bearing on latching or feeding. Primarily, controversy stems from an emergence of interventions being performed on superior labial frenula, such as surgical or laser removal, despite limited knowledge of what is “normal” or “abnormal” in relation to this frenulum. Nor is it known whether this frenulum has any functional consequences relating to its appearance or attachment. ![]() Subsequently, the typical versus atypical appearance of this frenulum is not known. There is growing controversy on the identification, classification, and subsequent significance of the superior labial frenulum in newborns, and when the presence of a frenulum is “lip-tie.” The undersurface of the upper lip is not part of the routine newborn clinical examination, and as such is an area not frequently assessed by clinicians. 1 It is made up of alveolar mucosa and arises embryologically as a posteruptive remnant of tectolabial bands. This fold of connective tissue, also known as the maxillary labial frenulum, originates at the midline of the undersurface of the lip. The superior labial frenulum is the soft tissue that attaches the upper lip to the anterior surface of the maxillary gingiva. ![]() As more procedures are done to release the upper lip frenulum, it is important to understand what degree of attachment is normal, or more common. The majority of infants had a significant level of attachment of the labial frenulum. Conclusions: The Kotlow classification of lip-tie fails to be reproducible by relevant experts. Raters had poor intra- and interrater reliability (64% to 74% and 8%, respectively), using the Kotlow classification system, which improved when the classification system was simplified. Results: All newborns have a labial frenula, with most attached at the gingival margins (83%). ![]() The raters assessed each photograph twice and were blinded to their previous rating and to other raters’ scores. Relevant medical professionals rated the appearance of the labial frenula using a previously described Kotlow classification system. Newborns were examined and had photographs taken of their upper frenula. Methods: A prospective cross-sectional study. Introduction and Objectives: There has been an emergence of procedures to release the superior labial frenula in infants, yet little is known about the normal appearance or incidence of severe attachment, or “lip-tie.” The objective of this article was to develop a classification system for superior labial frenula and to estimate the incidence of different degrees of attachment.
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