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By lifting the tongue or tilting the lip, we can see a slight fold that connects the tongue to the bottom of the mouth, or the lip to the gum. These are the frenulum. We meet them in different places of the human body.
The frenulum always connects two elements and to a greater or lesser extent limit their mobility. If they are too short or improperly built, the functions of the organs with which they are connected may be impaired. Surgical intervention is required. Often it concerns the sublingual frenulum.
A properly developed frenulum allows the tip of the tongue to reach all corners of the mouth. A shortened frenulum, or ankyloglossia (Latin), is the most common anatomical defect of the oral cavity, which limits the movement of the tongue, which causes many negative effects in the child’s developmental process. The shortening of the frenulum may vary in severity – from slight tension to strong thickening, and thus immobilization of the tongue.
Shortening of the sublingual frenulum in newborns
– Shortening of the sublingual frenulum – says Mira Rządzka, neurologopedist, early intervention specialist – can be diagnosed already at the first cry of a child, when the toddler’s tongue should assume a specific arrangement of the raised shoulder blade. On the other hand, with a shortened frenulum, a heart-shaped recess is observed on the edge of the tongue. This defect results in food intake disorders. The child cannot seal the nipple with a crown with a suckling movement, so he begins to press the food with the center of the tongue or squeeze out the food, intensifying the biting reflex. So the earliest consequence of this defect is the lack of a proper suckling reflex in the newborn and infant. Such a child, despite the sufficient amount of food, cries while feeding, stops suckling, you can see a clear effort on his part. When the consistency of food changes from the age of 6 and 7 months – incorrect food transport is noticed in children with too short a frenulum. A bite of food should be lifted upwards with the tip of the tongue and, with its wavy motion, given backwards to be swallowed. A child with ankyloglossia does not have such a physical ability, it is clearly difficult for him to eat. Also, the correct chewing reflex, which requires moving a hard bite of food with the rotational movement of the tongue between the molars, is incorrect. Later in life, an inappropriate reflex swallowing reaction becomes established – with the tongue lying flat or with the tongue being inserted between the teeth, which promotes the development of a malocclusion.
Leaking saliva
Another effect of a too short frenulum is the inability to properly arrange the mass of the tongue, which often lies in the resting position at the bottom of the mouth, preventing rapid outflow of saliva. As a result, a lot of saliva collects under the tongue, which sometimes causes it to leak out and makes parents uneasy.
Incorrect articulation and short frenulum
The end result of a too short sublingual frenulum is incorrect articulation of sounds. In Polish, correct pronunciation of many sounds requires lifting the crown of the tongue to the upper gingiva. Considering that the sounds / t /, / d /, / n / appear already in a 12-month-old child, and the sounds / l / around 2-3 years, shortening the frenulum from the very beginning causes their incorrect sound and pathological position of the tongue . In the further development of articulation, when the sounds / sz /, / ż /, / cz /, / j / and the most difficult of the sounds – vibrational / r / should appear, they are often not pronounced prototypically, but pathologically – the phenomenon of lisp pronunciation of humming sounds, and replacing / r / with / j / or / y / or / ł /. Often, with this problem, / r / is pronounced briefly and without vibration. Sometimes there are distortions of sibilants and husks.
Surgical procedure – phrenuloplasty
All this can be avoided by performing one of the frenuloplasty procedures under local anesthesia. Surgical treatment consists in either a transverse incision of the frenulum at its base – frenulotomy, or plastic excision of the frenulum – frenulectomy.
The morning heals quickly – in about 2,3 days – if we have a frenulotomy cut, it takes a little longer after the ligament is completely excised. However, after each treatment, a sublingual massage should be used according to the speech therapist’s instructions.
Performing a frenuloplasty procedure, especially concerning the tongue, is most beneficial for a child at the earliest possible age. In this way, it is possible for him to build from the beginning the correct nutritional, physiological and, in the future, articulation patterns. Undercutting the sublingual frenulum in old age also brings results, but then the child requires a long speech therapy, because the undercut will only increase the mobility of the tip of the tongue, and does not automatically eliminate the already established effects of the defect. After the surgical procedure is performed, it is therefore necessary to improve the tongue – that is, teach it a new, unknown function – lifting it up – standing upright. However, the most difficult task then is to change the way of articulation and prevent emotional problems in contacts with the environment and difficulties in learning to read and write (in writing it concerns the translation of unpronounceable sounds into their writing).
Myths about the frenulum
– A shortened frenulum causes the lack of active speech (not true, it can only cause articulation distortion).
– It is not worth undercutting, because it will grow anyway (if we do not stimulate the tongue, raise it, the morning may granulate, reducing the undercut).
– You do not need to undercut, because the frenulum can be stretched with massage (not every frenulum can be stretched in this way).
Read more: Sub-lip frenulum
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