SpeechPathology.com Phone: 800-242-5183

New master brand. Same great company. Introducing continued! Read Our Story

CRA Therapy Careers

Lingual Frenectomy: Candidacy and Considerations

Robert Mason, Ph.D,CCC-SLP

March 8, 2010



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.

Please visit the SpeechPathology.com eLearning Library to view courses on this topic and many other topics in the field.

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.

Related Courses

Assessment of Speech Sound Disorders in Children with Cleft Palate &/or VPD
Presented by Angela Dixon, MA, CCC-SLP


Angela Dixon, MA, CCC-SLP
Course: #6723 1 Hour
  'Clarifies so much!'   Read Reviews
(This is the 1st course in a 4-part series, SSD in Children with Cleft Palate and/or VPD.) This course will review the primary components involved in assessing speech sound disorders in children with cleft palate and/or velopharyngeal dysfunction (VPD). Functional tools/techniques will be highlighted with the goal of determining when speech therapy is beneficial and when further medical referrals are necessary.

Birth to Three - Special Considerations for Speech Sound Disorders in Children with Cleft Palate &/or Velopharyngeal Dysfunction
Presented by Anne Bedwinek, PhD, CCC-SLP


Anne Bedwinek, PhD, CCC-SLP
Course: #6718 1 Hour
  'Excellent video to show the exact concepts being presented'   Read Reviews
(This is the 2nd course in a 4-part series, SSD in Children with Cleft Palate and/or VPD.) This course will focus on special considerations needed during the first three years of life for the child born with cleft lip-palate and/or velopharyngeal dysfunction. Emphasis will be placed on referral to and collaboration with a child’s cleft palate-craniofacial team. Principles and techniques will be illustrated for use during the first three years of life.

Therapy for the Child with Cleft Palate or Velopharyngeal Dysfunction
Presented by Lynn Marty Grames, MA, CCC-SLP


Lynn Marty Grames, MA, CCC-SLP
Course: #6734 1 Hour
  'The information shared will be useful for me but the presenter ran out of time'   Read Reviews
(This is the 3rd course in a 4-part series, SSD in Children with Cleft Palate and/or VPD.) This course will focus on speech therapy techniques for the child with articulation disorder related to cleft palate or velopharyngeal dysfunction. Practical therapy techniques that can be adapted for children aged 2 through the teen years are included.

Cleft Palate - What do I hear? What do I do?
Presented by Mary O'Gara, MA, CCC-SLP


Mary O'Gara, MA, CCC-SLP
Course: #6733 1 Hour
  'The video and sound examples were helpful'   Read Reviews
(This is the 4th course in a 4-part series, SSD in Children with Cleft Palate and/or VPD.) Case studies will be presented to discuss assessment and therapy techniques for individuals with cleft and craniofacial conditions. Audiovisual recordings will be provided to demonstrate speech resonance, airflow control and articulation problems in this population. Therapy goal setting will be discussed, with specific techniques for compensatory articulation strategies.

Developing Phonological Awareness in Preschool Children: Why and How
Presented by Froma Roth, PhD, CCC-SLP


Froma Roth, PhD, CCC-SLP
Course: #6708 1 Hour
  'appreciated learning about the research behind phonological awareness'   Read Reviews
This course is part of the 2014 Nancy McKinley Lecture Series. Evidence-based information will inform this discussion of the critical developmental link between metaphonology and literacy. Developmental considerations will inform a description of key parameters of phonological awareness instruction, effective strategies for young learners, and examples of instructional sequences for advancing the metaphonological abilities of preschool children.