3 yr old vpi, dysarthria, ankyloglossia

Hi Sandra, I recently attended your short course offering.  I have some questions regarding my own daughter.  She suffered from Encephalitis at the age of 3 years, which she has since recovered from. She continues to have some Dysarthria (primarily lip/tongue weakness) which is residual from encephalitis vs. developmental (her speech was not clear prior to encephalitis). She also has a short frenulum. Whether or not she is “tongue-tied” has been debated by several pediatric SLP’s, dentists, and a couple ENT’s in my area. Question 1 – Have you ever heard of a short frenulum being a stabilizing factor in relation to dysarthria? One pediatric SLP felt that if we did a frenectomy it could make her speech worse. Question 2 – The second problem is that she has is VPI (velopharyngeal insufficiency). Her speech is characterized by hypernasality and inconsistent nasal emission. The ENT I consulted with up here felt that she just “needs more time to develop.”  Question 3- Do you have a recommendation for a team (preferably in the Pacific Northwest) that specializes in VPI that I could consult with, possibly fly to see and get some help?  Thank you for your time!

A:  Thank you for your note and your report of the discussion among professionals about your daughter.  I have consulted Dr. Robert Mason to assist me in responding to parts of your questions. 1) A short lingual frenum: We cannot envision why a release of a short lingual frenum would lead to further deterioration of speech. 2) Regarding hypernasality: this is not a condition that spontaneously ceases as a child grows and develops. A prosthetic device is seldom used, especially with individuals with dysarthrias since the gag reflex is almost always heightened. The procedure of choice is a plastic surgery procedure, usually now a sphincter pharyngoplasty, or in some instances, a posteriorly based pharyngeal flap. If there are neurological issues, the risks of intubation and general anesthesia may negate surgery, in which case a palatal lift removable appliance may be a possibility, but surgery is preferred. 3)  A team approach: certainly your daughter needs to be seen by a team that specializes in all of the conditions you mention. The most logical and excellent resource would be the cleft palate team at a Childrens Craniofacial Center near you.  We will provide you with the name of the hospital, the team leader, the email, and the phone number.  Dr. Mason is familiar with most of their team and can endorse them very highly.  Feel free to use his name in making contact with them.  Dr. Mason is a Past-President of the American Cleft Palate-Craniofacial Association,  and is therefore well aware of the talents of this team, and most of them would also know of him as well. We hope that it can be arranged for this team to see your daughter, and we are confident that whatever they recommend will be best for her. I hope that these responses help, and we will be interested to know how things progress. Please let us know if we can help in any other way. —

She responded: Dr. Mason, Thank you for your prompt, very helpful e-mail. I was relieved when I heard from you today. I’ve been frozen with indecision for awhile. Our plan is to deal with the frenum, wait for several months and then I will take your advice and contact the craniofacial team you recommended. I really appreciate your time and referral information. I will keep you posted and feel very blessed to have the ability to bounce things off of such a talented professional. Thanks again!