At the beginning of this school year a father referred his 11 year old son for lisping. Upon examination I noted that his frenulum was attached producing a highly defined heart shaped pattern. In other words, it was on the higher end of the scale for atta
I appreciate your knowledge and perspectives about surgical release of a tethered lingual frenum. Although I am not a fan of widespread lingual frenum surgery, I agree with you that there are some reasonable indications for the surgery. The heart-shaped configuration of a protruded tongue tip that you note is a classic sign of a short, tethered lingual frenum. The inability to effectively and efficiently sweep food from the oral vestibule is a reasonable accompanying indication for a frenectomy. The risks of post-operative problems are few and would not outweigh the potential benefit for most clients. The 11 year old boy you describe seems to be a good candidate for a lingual frenectomy.
I'm happy to read that the parents sought out a surgeon to perform the surgery rather than a general dentist or physician. The surgery would involve a lengthening procedure at the base of the tongue. A simple clipping of the frenum at this age would not be considered an effective procedure.
You also mentioned that the child's mouth is small. As you will recall, the tongue adapts to the environment in which it resides and should adjust easily at rest and in functions to the increased range of excursion provided by the surgical procedure.
I'm impressed with what you have already accomplished with this child in speech therapy. The adaptive skills that he has developed should insure a rapid improvement in speech articulation following lingual frenectomy. Nonetheless, I would encourage you to advise the child and parents that some therapy to aid the speech adaptation process may be needed following the surgery.
Since the father has already consulted a surgeon and surgery is scheduled for the summer, I do not see the need for you to pursue whether your recommendation for an additional consultation with a medical speech pathologist was honored. There do not seem to be any red flags involved here. While I appreciate your concern for the welfare of this child and the benefits/risks involved, I feel confident that the surgeon involved will properly apprise this family of all possible complications. I share your hope that this child will have an uneventful post-operative course following the lingual frenectomy.
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Robert M. Mason, DMD, Ph.D. is a speech-language pathologist (CCC-ASHA Fellow), a dentist, and orthodontist. He is a Past President of the American Cleft Palate-Craniofacial Association, a professional, interdisciplinary organization specializing in problems associated with facial and oral deformities. Dr. Mason has studied and written extensively about orofacial examination, developmental problems related to the tongue, and the anatomy and physiology of the speech and hearing mechanisms. His reports have appeared in speech, dental, medical, and plastic surgical journals and texts. He is considered to be an expert in tongue thrusting, tongue tie, and other problems related to tongue functions and speech.