That Darn Lingual Frenulum!

Friday, December 14, 2012

Hey! Did you know that "little web thing" under your tongue has a purpose? 
Well it does, and it is pretty darn important.

Your lingual frenulum connects your tongue to the base of your mouth. If your frenulum is too short, it can cause what the medical world calls ankyloglossia. We would call it "tongue tied"!

Ankyloglossia is congenital. There are some syndromes that exist where this is a common symptom. The frenulum can be part or completely fused to the base of the mouth causing ankyloglossia. 

How do you look for this? 
  • I complete an oral motor examination on every student that comes through my doors. 
  • The easiest way I have found is to ask the student to stick their tongue out and imitate me. 
    • ask the student to reach tongue to the roof of their mouth, this should be difficult.
    • ask them to stick their tongue out, you will notice the end of their tongue looks heart shaped and they will have trouble lifting tongue up to nose and down to their chin.
property of intelligent dental 

Ankyloglossia can cause a variety of problems:
  • Difficulty breast feeding, the baby would have difficulty latching onto and maintaining suction of the breast. This may result in a fussy baby, weight loss, or chewing on nipple (instead of sucking)
  • Some suggest anykloglossia may cause difficulty with speech sounds, specifically sounds made on the alveolar ridge /t, d, n, l/ and others involving careful placement of tongue tip /s, z, and r/.
  • Although a relationship has been made by some, there is currently no evidence to back this up! Some students may speak perfectly fine with a short frenulum and others may have difficulty. They may also be two different things that occur together...confusing enough?
  • Go with the evidence!!!  Kummer, 2005,  ASHA Leader Article
  • Leave it alone! Unless it presents with a problem in infants with feeding, a personal annoyance or difficulty as an adult (can we say french kissing? ha ha).
  • Frenulectomy- snipping of the frenulum by a doctor to allow more movement of the tongue. Hooray, it's free to move about! This is a short procedure usually and done while patient is awake. In more serious cases the patient is sedated. 
    • Although some believe that a frenulectomy is the "cure", it's not! In fact most of the time this surgery is not effective in fixing the student's articulation errors. So be wary what you suggest to parents! Best thing to do is treat the articulation and try different tongue placements the student can actually do successfully.
My own opinion: I have three students on my caseload with ankyloglossia. They present with difficulty with /s, z/ and /th/, as well as multisyllabic words (interesting it's not the /t, d, n/, like some suggest).   The student's articulation skills are improving without the surgery, however it seems to be slower than most students. Otherwise their speech is completely intelligible and there may be other factors affecting their articulation (Spanish influence or parent's history of articulation errors etc).

This picture is just too funny, I bet our students feel like this sometimes!
Property of Mr. Fibble

NOTE:Opinions are my own and not the views of my employer, some information summarized, including evidence regarding treatment was obtained from Kummer, 2005,  ASHA Leader Article

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18 Responses to “That Darn Lingual Frenulum! ”

  1. So interesting that you have not one but 3 kids on your caseload with this! Dentists and pediatricians are usually pretty good at catching this and fixing it. I've never worked with a kid with ankyloglossia, but I have a few on my caseload who had their lingual frenulum 'snipped' when they were younger... good to know what it would look like should I ever come across it!

    I love that you're doing this blog!! Please keep writing and I'll keep reading :)

  2. Cynthia, the population I work do not have access to great medical or dental care. I am finding this issue more and more! I always thought from what I learned in school that the "snipping" surgery was the way to go but I read somewhere it only fixes the problem 50% of the time. Then I found information from ASHA while writing this and was pretty shocked that it might not even help at all! ASHA counts self-study as part of CEUs and writing/reading blogs can count!

  3. Jasper was actually born with this. They noticed it when he couldn't latch on and had trouble feeding. They snipped it and as soon as I gave him a bottle (which was right away) he sucked like a champ.

  4. Cool! Yes, the surgery totally helps babies, it's awesome they can fix it!

  5. When an anterior tie is revised but there is still a posterior tie, there will still be problems. A a 55 yr old who just recently had my posterior tongue tie revised, I can tell you definitively that there are benefits to revising. Basically, as an IBCLC who works with many tongue tied infants who cannot breastfeed well, if a frenum is causing no issues, it is a frenum, but when it interferes with feeding and speech and eventually swallowing, sleep etc, it is a tie and needs to be addressed. Please read the work of Dr. Brian Palmer and Dr. Larry Kotlow for more information.

    1. Do not get me wrong, I think every child should have it fixed if they have one!

      Research has shown for articulation (ASHA research which is my governing board who we look to for their stand point) that it may or may not help improve intelligibility. I have a student who recently had his fixed (not even in for articulation) and now he talks so much more! Hooray for improved ROM of that tongue!!!

      I didn't go into the feeding part of it as that is not my area of specialty. That is a completely different world, with another set of research to back that up. When feeding is involved it definitely needs to be addressed.

      The problem relating to articulation is the error may be present despite the frenum, so if it gets fixed it may not even help.....

      I will check out the reference you mentioned! Thanks for sharing!

  6. Sry if this published twice. .but wondering why I can't find more threads on .those born without a lingual frenulum. I'm 36. Had serious sinus issues..surgeries done.. and just today ..after many post appts to latest surgery ...realized I don't have one. Yes I can reach far up into my nose. Gross. I know.. but feel there's problems linked with this. any knowledge anyone?

    1. I know this is an old post, however I came across your comment in my search for "no lingual frenulum". I'm a mother of two, both born without a frenulum and both had difficulty breastfeeding. I questioned if the issue was related to the lack of this thin membrane under the tongue. The lactation consultant was unaware the lack of a frenulum even existed. My Internet search only lead me to a connective tissue disorder called, Ehlers Danlos. Both children have edured sinus issues, and my recent internet quest to find an answer has led me to this thread. My daughter is now 20 months old and is experiencing speech delay. I am questioning whether the difficulty comes from her chronic ear infections or the lack of a frenulum. I have spoken with the speech therapist about the issue, and she too was unaware that the lack of a frenulum could affect speech development and knew very little about it. I was intrigued to read that you too have suffered from sinus related issues and wondered if the "frenulum issue" was ever addressed to your ENT doctor? I never thought about putting the lack of the frenulum together with the sinus related issues that have caused all the ear infections. I agree that there is a lack of information concerning the subject...

  7. my daughter had much difficulty nursing as a result of this and no one told us until she was grown that this could have accounted for her inability to successfully nurse. She has had a severe sleeping disorder since infancy and I wonder if anyone has any data on whether this condition can and does affect breathing esp. in sleep?

    1. Dina as an SLP who is studying this area at length. YES, it can absolutely effect breathing! There is a lot of new research coming out on this topic!

  8. do we need that to be able to talk thou? what if we split or cut off that thin layer under the tongue? will we be able to still talk and move our tongues around? do we need that thin layer to be able to talk?

    1. Gee, I don't know. We can talk with them and eat foods with them!

  9. I have a tight frenulum (or frenum) and also a HUGE tongue base (as my ENT was delighted (he couldn't stop being amazed) to keep repeating to me. It's HUGE. It's enormous. I also have snored all my life & now have a CPAP.
    Two of my children (of 4) had this problem. It is genetic. I want to have my frenum cut because I cannot roll the R's when speaking Spanish. But I am afraid that my HUGE tongue base will slide back and choke me when sleeping. Any thoughts?

  10. I don't have one of those things to hold my tongue down

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