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Abusive torn frenum

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


Comparative studies of torn frenum

  • A prospective study of all children less than 3 years examined within 24 hours of intubation noted that only 1/105 children sustained an oral injury as a consequence of intubation (broken tooth), and torn frena were only observed in 3/14 abused children 1
  • One child had a lower frenum tear with associated lib abrasion
  • Another child had an upper frenum tear with associated swelling to the lips, bruising to the tongue, blood on the teeth, multiple human bites and eyelid bruising.
  • The third child had a healed frenum scar with associated bruising to the lip, cigarette burns and subconjunctival haemorrhage
  • 2/3 children had associated fractures
  • These children were aged, 5, 17 and 21 months

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  1. Lopez MR, Abd-Allah S, Deming DD, Piantini R, Young-Snodgrass A, Perkin R, Barcega B, Sheridan-Matney C. Oral, jaw, and neck injury in infants and children: From abusive trauma or intubation? Pediatric Emergency Care. 2014;30(5):305-310 [Pubmed]

Non-comparative studies of abusive torn frenum

  • 15 studies addressed abusive torn frenum 1-15
  • Included data on 35 children with an abusive torn frenum 
  • Approximately 90% were fatally abused (where details given) 
  • Age: 30 aged 5 years old or less where details are given
    0-10 years for 5 children 12 
  • 13 children had associated head injury 2-11,13-15
  • Nine children had fatal head injury 2,5,7,8,11,13,14
  • Five children had fatal abdominal injuries 12
  • One fatality had coexistent ano-genital sexual abuse with multiple fractures 9
  • Torn frenum was first recorded as an abusive injury in 1966 1
  • Two infants (aged six weeks and three months respectively) presented with an unexplained torn frenum and no thorough investigation; they re-presented within three weeks with multiple severe injuries 15

Mechanism of abusive torn frenum:


  • The only mechanism of injury recorded in the literature was a direct blow to the mouth, although no precise mechanism was recorded for the majority of the cases 14,15

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  1. Cameron JM, Johnson HRM, Camps FE. The battered child syndrome. Medicine, Science and the Law. 1966;6(1):2-21 [Pubmed citation only]
  2. Cordner SM, Burke MP, Dodd MJ, Lynch MJ, Ranson DL, Robertson SD. Issues in child homicides: 11 cases. Legal Medicine. 2001;3(2):95-103 [Pubmed]
  3. Datta S, Stoodley N, Jayawant S, Renowden S, Kemp A. Neuroradiological aspects of subdural haemorrhages. Archives of Disease in Childhood. 2005;90(9):947-951 [Pubmed]
  4. Ghahreman A, Bhasin V, Chaseling R, Andrews B, Lang EW. Nonaccidental head injuries in children: a Sydney experience. Journal of Neurosurgery. 2005;103(3 suppl):213-218 [Pubmed]
  5. Gilles EE, Nelson MD Jr. Cerebral complications of nonaccidental head injury in childhood. Pediatric Neurology. 1998;19(2):119-128 [Pubmed]
  6. Grace A, Grace S. Child abuse within the ear, nose and throat. Journal of Otolaryngology. 1987;16(2):108-111 [Pubmed]
  7. Hicks RA, Gaughan DC. Understanding fatal child abuse. Child Abuse and Neglect. 1995;19(7):855-863 [Pubmed]
  8. Hill IR, Denham DA, Scholtz CL. Toxocara canis larvae in the brain of a British child. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1985;79(3):351-354 [Pubmed]
  9. Hobbs CJ, Wynne JM. The sexually abused battered child. Archives of Disease in Childhood. 1990;65(4): 423-427 [Pubmed]
  10. Manning SC, Casselbrant M, Lammers D. Otolaryngologic manifestations of child abuse. International Journal of Pediatric Otorhinolaryngology. 1990;20(1):7-16 [Pubmed]
  11. Phillips VM, van der Heyde Y. Oro-facial trauma in child abuse fatalities. South African Medical Journal. 2006;96(3):213-215 [Pubmed]
  12. Price EA, Rush LR, Perper JA, Bell MD. Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children. The American Journal of Forensic Medicine and Pathology. 2000;21(4):307-310 [Pubmed]
  13. Symons A, Rowe P, Romaniuk K. Dental aspects of child abuse: review and case reports. Australian Dental Journal. 1987;32(1):42-47 [Pubmed citation only]
  14. Tate RJ. Facial injuries associated with the battered child syndrome. British Journal of Oral Surgery. 1971;9(1):41-45 [Pubmed citation only]
  15. Thackeray JD. Frena tears and abusive head injury: a cautionary tale. Pediatric Emergency Care. 2007;23(10):735-737 [Pubmed]


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