Dear Dr.
Is it ever appropriate for a speech-language pathologist to refer a
patient to an ENT recommending clipping of the lingual frenulum when a
child has decreased tongue mobility? Can't the poor articulation skills
of a child be caused by the lingual frenulum being too short? A complete
oral motor evaluation revealed reduced tongue elevation and
lateralization. Could a short lingual frennulum be one of the possible
causes? ( Others may be motor a motor problem such as apraxia) A
pediatrician told me that clipping is no longer done. The pediatrician
said that recent research has found that clipping is not effective and
it is no longer done. Can you give me some insight on this topic.
Thanks,
Reply: ------------------
I am not familiar with the research that your pediatrician is referring to, but it is a fair statement to say that "clipping" of the lingual frenulum is not very often indicated. The lingual frenulum is a band of tissue located beneath the tonque in the midline of the floor of the mouth. In some cases this band is so short that it tethers the tip of the tongue down occasionally to the point that when an attempt is made to protrude the tongue, a crease or invagination of the tongue tissue occurs. This condition is known as anklyoglossia. In most cases, this is felt not to significantly affect speech or swallowing. However, this issue is best determined with the help of an experienced speech therapist. It is my opinion that if an assessment by an experienced speech therapist results in an opinion by the therapist that articulation errors are directly related to anklyoglossia, then I will recommend this surgery. "Clipping" the lingual frenulum is a very minor operation, although it usually requires a brief general anesthetic. Complications are rare and remote. The child can eat and drink the same day with only mild discomfort.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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