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  • Writer's pictureSteven Rea

Let's Talk About Tongue Tie


I recently started speech therapy with a new 4th grade student to one of my schools. She is showing a mild and inconsistent distortion of the R sound. So, sometimes 'car' sounds like 'cow' or 'bird' sounds like 'bood.' In my attempts to promote some carry-over of her many, many good R productions into her conversational speaking I brought to her attention the fact that she is producing the R sound correctly much of the time. She then told me that her mom said her speech problem is because she is 'tongue tied' and that she was supposed to have scheduled an appointment to have it clipped. This prompted me to refresh myself on what I had learned in college about tongue tie.

A small band of mucous membrane—a frenulum (or frenum)—connects the middle part of the tongue to the bottom part of the mouth. This band helps stabilize the tongue for sucking, swallowing, eating, and speaking. Some children are born with fusion (either partially or completely) of the tongue to the bottom of the mouth. People often refer to this abnormality as being 'tongue-tied.' The technical name for tongue-tie is ankyloglossia. Surgery to release the tongue is a frenulectomy or as many refer to as 'tongue clipping. Different problems can occur due to tongue-tie such as issues with feeding, dentition, cosmetics and personal interactions, and many professionals believe speech as well.

Through the ages, it has been a common folk belief that if the tongue tip cannot move well due to being 'tongue tied', it must affect speech. This is even mentioned in the Bible. In Mark 7:35, it says “… and the bond that tied his tongue was loosed, and he talked plainly.” Despite this common belief, there exists no empirical evidence in the literature that ankyloglossia typically causes speech defects. Even with the lack of evidence many professionals still believe that ankyloglossia is a common cause of speech problems. In a recent survey, Messner and Lalakea (2000) found that 60% of ENTs, 50% of SLPs, and 23% of pediatricians believed that tongue-tie is likely to cause speech problems.

We cannot look past the fact that both ankyloglossia and speech problems commonly occur in children and that it is not surprising that these conditions can occur together. A co-occurrence of two common problems does not mean that there is a causal relationship, however. Instead, when there are speech problems and ankyloglossia, this may be a co-incidence and other causes for the speech problems should be considered.

When ankyloglossia is noted at birth, one option is to leave it alone and let nature take its course, unless there are early feeding problems. If the child demonstrates any of the problems noted above, a frenulectomy, or tongue clipping (surgical release of the tongue) can be done. Frenulectomies are usually done by either a general surgeon, an otolaryngologist, a plastic surgeon, or an oral surgeon. Although these surgeries are commonly done, there does not appear to be consistency in what are considered indications for the surgery. In a survey of oral and maxillofacial surgeons, plastic surgeons, and pediatric general surgeons in Australia who perform frenulectomies, Brinkman et al. (2004) reported that “There was no clear consensus regarding clinical indicators for surgery or functional outcomes following surgery.” Tongue-clipping can be done in the office with no anesthetics. In older children, the operation requires general anesthesia to ensure adequate cooperation from the patient to gain access to the floor of the mouth to perform the procedure. The frenulum is divided with scissors or with electrocautery. The band is thin, and generally requires no sutures. The procedure takes only a few minutes to perform. Tongue mobility is generally adequate to prevent adhesions from forming that may again limit tongue mobility. Risks of frenulectomy are very low, but may include pain, minor bleeding, or infection.

To summarize; there is virtually no evidence in the literature to establish a definite causal relationship between tongue-tie and speech disorders. In fact, there is very little in the literature that addresses ankyloglossia and speech at all. This is probably because a causal relationship is not what is typically seen clinically. Therefore, it can be assumed that tongue-tie is unlikely to cause speech problems in most cases.

Most experienced speech-language pathologists would conclude that frenulectomy or tongue clipping is rarely indicated for speech reasons unless it is very severe or there are concomitant oral-motor problems. It may, however, be warranted for problems with early feeding, bolus manipulation, dentition, or aesthetics. Although tongue clipping is a minor procedure, the true danger may be the disappointment that can result when parents are led to believe that this will correct speech problems that are actually due to other causes.

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