In some areas of the body there are small folds or strips of tissue called "frenuli", which have the task of holding back or controlling the movement of other areas of the body. These are strategically positioned to best perform their function. A classic example of a frenulum is the small membrane that joins the tongue to the base of the mouth. Frenuloplasty is a necessary surgical procedure when these flaps are too constricting. The two most common interventions are penile frenuloplasty and oral frenuloplasty, which are necessary, respectively, when the frenula of the penis and tongue are too short. As for the male genitalia, the frenulum connects the area of the penis called the foreskin to the glans. If this flap is too short, the penis bends unnaturally during erection and the individual feels pain during sexual intercourse or with erection alone. On the other hand, when the lingual frenulum is too constricting, we are faced with a pathology known as ankyloglossia that interferes with the ability to speak, eat and with proper oral hygiene.
Steps
Part 1 of 5: Preparing for Penis Frenuloplasty
Step 1. Assess the risks of the operation
All procedures involve dangers, even outpatient or day-surgery ones.
- Two very common consequences in this type of surgery are swelling and bruising.
- In rare cases, the bleeding may last for a while and other interventions may be needed to stop it.
- Infections are unlikely but possible and will need to be treated with antibiotics.
- It is also likely that scar tissue may form at the surgery site.
Step 2. Ask the andrologist to explain the various possibilities
Circumcision or other procedures specific to your condition can correct the frenulum problem of the penis as well.
A study showed that between 15 and 20% of men who chose frenuloplasty, despite the surgeon advised them to have circumcision, later had to undergo circumcision as well. On average, this second surgery was performed 11 months after the first
Step 3. Stop smoking
This bad habit contributes significantly to the development of postoperative complications.
- Try to stop as soon as possible while you wait for the day of the operation. Even just a few days without smoke have a positive impact on recovery.
- The sooner you stop for the surgical procedure, the better the prognosis will be. Smoking impairs the body's ability to heal.
Step 4. Talk to your doctor about anesthesia
Many surgeons prefer to perform the surgery under general anesthesia.
- General anesthesia requires the patient to sleep during the operation.
- Sometimes people opt for epidural anesthesia, an injection of anesthetic drug directly into the spine that takes away feeling from the waist down.
- In some cases, local anesthesia is used (only in the penile area), although it is not a very common choice. In this case the anesthetist performs an injection of anesthetic in the genital area.
- An alternative is intravenous sedation. Sleep-inducing drugs are injected into the vein, but these are not as potent as those used for general anesthesia.
Step 5. Follow the surgeon's instructions
Since general anesthesia is preferred in most cases, you will need to follow a specific procedure before undergoing the surgery.
General guidelines recommended for patients undergoing general anesthesia require the individual to eat and drink nothing, including water and chewing gum, for a specific period prior to surgery. You will usually be instructed to fast from midnight before the operation
Step 6. Take a bath or shower
The time you need to wash and the products you need to use will be indicated on the forms and instructions given to you by the surgeon.
- Some doctors prefer that certain soaps are used before surgery. One example is the disinfectant called chlorhexidine which cleans the skin deeper than regular soaps and reduces the chances of infection.
- The andrologist will tell you which products to use for your hygiene and when to wash.
Part 2 of 5: Preparing for Oral Frenuloplasty
Step 1. Understand the risks of the operation
In each surgery there are possible dangers and in this case the most common, albeit rare, are:
- Excessive bleeding
- Infection at the surgery site;
- Damage to the tongue;
- Damage to the salivary glands;
- Formation of scar tissue on the affected area;
- Possible allergic reactions to anesthetic drugs;
- The frenulum heals again in the wrong position causing a recurrence of the problem.
Step 2. Ask the doctor if the operation is essential
This type of problem is usually identified at birth and the surgery is performed on the patient who is still a newborn or very young. Your surgeon will discuss the various options with you if these are available.
- In some situations, the procedure is mandatory.
- When the lingual frenulum is short, thickened and binds the tongue to the floor of the mouth, then the only option is surgery, to free the tongue and allow it to move normally.
- This abnormality interferes with the baby or toddler's ability to eat, suck on the bottle or nipple, speak normally, swallow, and cause problems with tooth and gum development.
- Among other complications, ankyloglossia makes good oral hygiene difficult, all activities that involve the use of the tongue, such as licking an ice cream cone and lips or playing certain musical instruments.
Step 3. Have your newborn child for outpatient surgery
If the baby is less than three months old, the procedure can also be performed on an outpatient basis.
For infants and children over this age, doctors generally recommend surgery under general anesthesia
Step 4. Ask the surgeon about anesthesia
When the patient is a child, the procedure takes a few minutes and the anesthesia is actually intravenous sedation.
- The surgeon will advise you on the safest type of anesthesia for the baby. Both general and sedation require preparatory procedures that must be followed at least eight hours before entering the operating room and usually begin the previous evening.
- Follow your doctor's instructions. The main ones concern the suspension of food and liquid intake for a certain number of hours before surgery; in general, fasting must be respected from the previous midnight.
- The operation usually takes less than 15 minutes.
- Depending on the severity of the situation, a few stitches may be required.
Part 3 of 5: The Day of the Surgery
Step 1. Be prepared to answer several questions
As soon as you arrive at the hospital or clinic, you will need to sign some informed consent forms, stating that you understand the procedure, and other documents regarding the ward's management policies.
- You will be asked a few questions about your general health, including the time you last eaten or drank something.
- You will need to provide information about any medications you have taken in the past 24 hours, your alcohol consumption and whether you are a smoker.
Step 2. Put on the hospital gown
You will need to undress and put on the special gown that will be provided to you.
- When you are properly dressed, you will need to lie down on a stretcher, a bed with wheels, and you will be taken to an anteroom outside the operating room.
- At this point, a venous access will be inserted and you will be given medications to help you relax and fall asleep.
- The actual surgery lasts between 15 and 45 minutes in the case of frenuloplasty of the penis, while for the oral one it usually takes less than 15 minutes.
Step 3. Expect to see the nurses when you wake up
You will be woken up in your room, your fever, blood pressure, respiratory rate will be measured and the staff will check the surgery site.
- Many people feel nauseous after undergoing general anesthesia. If this is the case for you, inform the nurse and ask him to give you a medicine to overcome the discomfort.
- As the effects of the anesthesia wear off, you will experience mild pain. Again, inform the nursing staff to give you a pain reliever.
Step 4. Start drinking and eating
As soon as you feel comfortable doing this, take a few sips of water.
When you are more alert, you can eat something light and drink as usual
Step 5. Prepare to go home
Most patients are discharged on the day of surgery.
- In some cases it is better to spend the night in the hospital, just to be safe, but this is a decision that must be made by the surgeon.
- You can go home when you feel fully alert, you can eat and drink without feeling nauseous, the wound does not bleed and you can urinate without problems.
Step 6. Have someone take you home
You probably won't be able to leave the hospital until the staff have made sure there is a person to drive the car for you.
- Since you still have some anesthetic residue in your body, it's not sure if you get behind the wheel.
- You shouldn't drive for at least 24 hours after surgery or for as long as your surgeon recommends.
Part 4 of 5: Recovering from Penis Frenuloplasty
Step 1. Pay attention to any complications
Tell your doctor if you notice continued bleeding or signs of infection.
- Check the wound every day. If you see discharge, the surgical site smells bad, or the area is swollen and red, then contact your doctor. In this case there is a risk that an infection is developing.
- Also inform the surgeon if you have trouble urinating.
Step 2. Do not apply any dressing to the wound
It is normal for the incision to bleed or ooze a little in the first few days after frenuloplasty. The amount of fluid or blood is minimal, but still visible.
- You may notice blood stains on your underwear or clothing in the days following the surgery.
- While it is not necessary to bandage the wound, you can use a small gauze pad at your discretion if you feel uncomfortable staining clothing and sheets with blood and secretions.
- You can attach a small dressing, such as 5x5cm gauze, to absorb blood or fluids.
- Tell your doctor if the wound is actively bleeding.
Step 3. Have an adult with you
In the first 24 hours after frenuloplasty, you should be looked after by another adult.
- Do not lock the doors of private rooms, such as the bathroom or bedroom, in the first few days of recovery because the person who cares for you may need to reach you quickly.
- Rest at home. Stay in a reclining chair or take naps in bed all day.
- If you feel dizzy or faint, lie down.
- Do not try to exercise and do not use any type of heavy machinery or appliances in the first few days following discharge from the hospital. It will take two or three days to regain strength.
Step 4. Return to your normal diet gradually
Drink lots of fluids, but avoid caffeinated drinks, such as tea or coffee. You can possibly limit yourself to small quantities.
- During the early days, follow a light diet. Stick to soups, small meals, and sandwiches for the first couple of days.
- Don't eat greasy, spicy, or heavy-to-digest foods, as they may make you feel nauseous.
- Do not drink alcohol for at least 24 hours after frenuloplasty.
Step 5. Take pain relievers
If you experience pain or discomfort, take acetaminophen or the pain relieving medications prescribed by your surgeon.
- Only take medicines that your doctor deems safe.
- Always follow the instructions on the drug leaflet and do not exceed the recommended or prescribed dosage.
Step 6. Don't tease the stitches
If these are visible, do not pull or cut them.
- Ask your surgeon about the type of stitches that were placed on you during the procedure.
- Most surgical threads are absorbable, which means that the body will metabolize them within three weeks. However, some doctors prefer to use traditional ones, which need to be removed by a professional after some time.
- Depending on the type of suture used, you will have to wait a few days before you can wash or shower. Ask the surgeon when you can return to your normal personal hygiene habits.
- Wear loose clothing to avoid friction between the fabric and the wound which could cause irritation.
Step 7. Refrain from sexual activity
Your doctor will be able to tell you how long to wait before having new intercourse.
- It is generally recommended to avoid all sexual activity for 3-6 weeks, depending on the extent of the surgical wound.
- If you wake up with an erection, try to get up, go to the bathroom, or walk for a few minutes to get your penis back to rest.
- Do not touch the genital area for 48 hours after surgery, except when you shower or need to urinate.
Step 8. Get back to work
You can return to work as soon as you feel able.
- Most men start working again within a few days.
- Some more complicated procedures require a longer convalescence, even up to two weeks. The surgeon will let you know when you can return to your normal daily activities.
- Give yourself several days to regain your energy and get back to feeling fit. It takes time to work off the last effects of anesthesia.
Step 9. Get back to training
You can start exercising again gradually several days after frenuloplasty.
- Avoid activities that can irritate or put pressure on the penis for a longer period. For example, don't ride your bike for two weeks.
- Ask your doctor when you can return to specific sports that require a tight bandage of the groin area or that could irritate the genitals. The andrologist will be able to give you all the necessary information.
Step 10. If the pain does not go away, tell your doctor
Once the proper recovery period has elapsed, sexual activity should no longer be painful.
If you continue to experience pain with your penis when erect or during sexual intercourse, call your andrologist to discuss the results of the surgery and possible options
Part 5 of 5: Recovering from Oral Frenuloplasty
Step 1. Know that the area will be a little sore and swollen
It is quite normal for the tongue to become a little swollen, painful and uncomfortable in the days following the operation.
- However, this is a mild and manageable discomfort with over-the-counter medications taken according to the doctor's instructions.
- Make sure that the surgeon, in the discharge letter, has indicated the exact products to give to your child to help him cope with the pain.
- The instructions must be clear on both the dosages and the safe products to give to the child.
- Do not exceed the doses indicated by the surgeon and do not use a different drug than the one prescribed.
Step 2. Try to breastfeed your baby
If he is very young and has had some difficulty feeding before frenuloplasty, try to breastfeed him immediately after the surgery.
This type of surgery leads to immediate results. Although the tongue is a little swollen and the baby feels some discomfort, he will still be able to breastfeed immediately after the surgery
Step 3. Have him do salt water rinses
If the child is old enough, encourage him to rinse his mouth frequently with a saline solution.
Your surgeon will certainly have given you all the specific instructions to reduce the risk of infection and to make the best use of the products recommended for young children
Step 4. Make sure your mouth is as clean as possible
Help your child with normal oral hygiene activities. He should brush his teeth and rinse his mouth as usual to keep his mouth clean and prevent infections.
- Do not touch the incision site with the toothbrush or your fingers, as this will irritate and infect it.
- If sutures have been applied, they are most likely resorbable. In some situations, however, traditional stitches are necessary, which must then be removed by the surgeon during a scheduled follow-up visit.
Step 5. Provide the baby with food and drink according to the doctor's instructions
He will tell you which specific foods you should not offer the baby or child and for how long. Follow his advice scrupulously.
Follow the mouth cleaning procedure that your surgeon explained to you. You will need to perform these steps after every food and drink to avoid infections
Step 6. Make follow-up appointments according to the surgeon's instructions
Depending on the age of the child, subsequent visits to a speech therapist's office may be required.
- This anomaly of the lingual frenum causes several problems, including phonetic limitations. Your child may have learned to make sounds and articulate words in an unnatural way in an attempt to communicate.
- By working with a speech therapist, the child will be able to correct speech defects and learn to speak normally. Tongue exercises are part of the process of strengthening this muscle and learning to vocalize normally.
