Tuesday, May 28, 2013

Lingual and Labial Frenulums

As SLP's we are frequently asked to evaluate not only if speech-language and swallowing skills are typical but also we are asked on the normalcy of the oral cavity itself. This brings me to my post tonight...oral frenulums!

1. What is a oral frenulum?
There are three different frenulums within the oral cavity. All of these frenulums are mucus membranes.  As you can see in the graphic below there is the superior labial frenulum, inferior labial frenulum and the lingual frenulum.

2. What is the SLP's role with oral frenulums?
The most common order I personally receive in the presence of an ankyloglossia is to evaluate if the patient will be able to produce all of his or her speech sounds/phonemes in conversation. An ankyloglossia is congenital anomaly where there is a partial fusion or a total fusion of the tongue by the frenulum to the floor of the mouth.

I encourage all of you to read the publication that I have linked below from ASHA that goes into much greater detail into the decision process of a frenulectomy. This article was very interesting, it reviewed the perspective of SLP's and other medical professionals in relation to the presence of the ankyloglossia and abilities in speech production. Many SLP's and medical professionals thought that it would negatively affect speech production. Now this is not always the case - I have personally worked with a patient with an ankyloglossia and functionally was able to produce all speech sounds and was able to utilize his tongue functionally for swallowing. Another consideration is that even if the patient has an ankyloglossia this doesn't mean that the patient has to produce a phoneme such as the /s/ in a traditional position (apex of the tongue elevated towards the alveolar ridge) - you could always attempt lowered position for the /s/. 

So will the presence of an ankyloglossia negatively effect speech production? Sometimes. Every patient is different with their needs in the case so it is important to look at the child as a whole person, consider function, and collaborate with the patients parents and primary care physician.

The two other oral frenulums include the superior labial frenulum and the inferior labial frenulum. I'll have pictures of these two below. For those of you who are working with the new born population these frenulums and the ankyloglossia can have a great effect on the baby's ability to latch on during feedings. I'll show a couple of pictures as an example below but I highly encourage you all to do further reading from this pdf file listed below!

Inferior Lingual Frenulum

Superior Lingual Frenulum

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