Tongue tie

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"Tongue-Tie" Article written for the "Expert Column" for the Golden Gate Mother's Group

Written by Kim Scott Deland, M.S., CCC-SLP, Speech Pathologist 

Q. My son has a short frenulum (tongue-tied). When he was a baby his pediatrician said if it didn’t interfere with his feeding, then it’s not a big deal. At the time my husband wanted it to be clipped, but I didn’t. Now my son is having speech issues, and my husband thinks we should get it clipped sooner rather than later. Has anyone had any experience/have any input on my situation?

A. When a child has a restrictive or tight frenulum, it can impair the ability of the tongue to move properly, affecting the child’s speech development. As well as having a speech function, the tongue is needed for sucking, chewing, swallowing, eating, drinking, sweeping the mouth for food debris, etc. Tongue-tie can resolve in early childhood if the frenulum “loosens” by itself, allowing the tongue to move freely for eating and speech. However, in some cases, the child may need to have an operation (frenectomy) to release the tongue. In order to develop speech, the tongue needs to make an amazing range of movements: tip-elevation, grooving and protrusion. The tongue should be able to make a range of movements in all directions for the articulation of a number of sounds, particularly l, r, t, d, s, n, th, sh and z. These sounds are likely to be distorted if a child has limited range of lingual movement. If a surgeon and a Myofunctional Therapist agree that surgical intervention is required, the surgical procedure to correct this condition is very simple. If the child is cooperative, it could even be done under local anesthesia. Therefore, mothers need not be overly concerned if this condition is the sole cause for the child’s speech problem. 

In my experience, I have seen many children who have undergone several years of speech therapy with little or no improvement until the tongue-tie is corrected. I almost always recommend surgery to avoid this situation. Speech therapy can be expensive and frustrating for a child if there is little or no progress. I recommend children get the surgery as early as possible because delaying surgery may result in the child needing more intensive speech therapy after surgery to correct any altered speech patterns. If surgery is done before speech develops, it is more likely that speech therapy will not be necessary. 

Posterior tongue tie (ankyloglossia) is a shortening of the frenulum of tongue, thereby limiting his mobility. The shortening of the bridle – a birth defect. Newborn posterior tongue tie causes disturbances in the process of sucking. In older children it can be a malocclusion, speech defects and problems with swallowing.

There are four types of posterior tongue tie:

In the first type of posterior tongue tie the frenulum is short and thin and does not contain large vessels.

In the second type of posterior tongue tie bridle short and thick, with a content of large blood vessels and connective tissue.

while the posterior tongue-tie is characterized by the thickening brake (type III)

or a submucosal brake (a wide, flat mound lingual ) which restricts movement to the base of the tongue (type IV).

Posterior Tongue Tie type 1 above:

Frenulum insertion occurs at the tip of the tongue. When the baby cries, tongue or heart-shaped appears bifida, as the bridle pulls the tip of his tongue into her mouth.

Posterior Tongue Tie type 2 above:

The insertion occurs bridle few millimeters further back than type 1. The language is not usually see bifida, but when the baby cries, you can see the tip of the tongue falls down.

Posterior Tongue Tie type 3 Rear:

This type of bridle could be defined as a combination of types 2 and 4, since there is little visible membrane at the back of the tongue but also a submucosal anchor, so not enough to sever the membrane to release the tongue floor of the mouth.This type of bridle may be difficult to observe with the naked eye, but just spend a finger from side to side under the tongue resting baby to notice him.

The tongue may have a normal appearance and perform extension movements with relative ease, but doing so will warp the periphery and become depressed in the center, and the baby can not raise it to touch the palate with mouth wide open. Depending on the thickness and woodiness of the submucosal component, the tongue may also present a matted and compact appearance.

Posterior Tongue Tie Type 4 bridle later:

Bridle as such is not seen with the naked eye because it is hidden under a layer of mucosal tissue, and almost totally restricted mobility of the tongue, so it is very anchored to the floor of the mouth and can present a compact appearance.The movement of the tongue is usually asymmetric. Often a pointed or narrow palate, a direct consequence of the low mobility of the tongue is appreciated.

■ Kim Scott DeLand, M.S., CCC-SLP, Speech and Language Pathologist, is the owner of Speech Therapy 101. She can be reached at [email protected]

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