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Torn frenulum and non-accidental injury in children
  1. Stewart Teece, Clinical Research Fellow,
  2. Ian Crawford, Senior Clinical Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether a torn frenulum in a child is indicative of non-accidental injury. Altogether 104 papers were found using the reported search, of which none presented any evidence to answer the clinical question. It is concluded that there is no evidence available to answer this question. Further research is needed.

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    Report by Stewart Teece, Clinical Research FellowChecked by Ian Crawford, Senior Clinical Fellow

    Clinical scenario

    A 2 year old boy is brought to the department with bleeding from a mouth injury. His father states that he fell over pushing his dummy into his mouth. The child has no other obvious injury and although the mechanism of injury sounds plausible you find a torn frenulum on examining his mouth. Remembering this as an indicator of non-accidental injury you wonder whether this injury alone is sensitive/specific enough to support this diagnosis.

    Three part question

    In [a child] with [a torn frenulum] what [is the sensitivity and sensitivity of this sign as an indicator of non-accidental injury]?

    Search strategy

    Medline 1966-10/04 using the Ovid interface. [exp Labial Frenum OR exp lingual frenum OR frenum.af. OR frenulum.af OR exp lip OR lip.af] AND [exp Child abuse, sexual OR exp Child abuse OR abuse.af OR exp Battered child syndrome OR batter$.af OR exp Violence OR violen$.af OR assault.af OR non-accidental.af OR dummy.af OR dummies.af OR exp Sucking Behavior/OR exp Pacifiers OR pacifier.af] LIMIT to human AND English language.

    Search outcome

    Altogether 104 papers found none of which answer the three part question.

    CLINICAL BOTTOM LINE

    There seems to be no evidence for the sensitivity/specificity of torn frenulum in the investigation of non-accidental injury.

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