A 4 year old client of mine had a frenectomy at the end of the school year. I didn’t see him over the summer but he was seen by someone else. He was not cooperative with the other therapist for oral motor exercises. I am now seeing him again and have just ordered your 2 and 3 way mouth props which I’m hoping he will be able to tolerate with his strong gag reflex. I watched your website videos which were very helpful. I still have concerns about the success of the frenectomy. While he is capable of lateral movements (while therapist stabilizes jaw) – he has very limited forward excursion (does not extend past lower lip and still has heart-shaped tip) and when he attempts to elevate his tongue to sweep his upper lip he uses his teeth to stabilize his tongue. Should Mom bring him back to the ENT? What should one expect post surgery? T
I’m so glad you contacted us about this young man’s situation. First of all, it is advisable to do some exercises shortly after the frenectomy. The exercises can be disguised as “silly tongue games” as long as the goals are met. I’m sorry he wasn’t willing and able to work on exercises right after the surgery. The initial goals are to have him be able to separate mandible and tongue in the horizontal, lateral and vertical dimensions with ease and consistently. The 2 or 3 Way Mouth Props will be needed to start off, but then he should be able to make the excursions without the assistance of the Mouth Props or anything else (ie., tongue depressor, manual assistance from you, etc.). To know whether further surgery is needed or not, you have to be sure that the remaining difficulties have structural components rather than just functional. If they are caused by structural restraints, he would need to be seen again by the ENT to consider further release. He most certainly should be able to stick his tongue out beyond his lips at this point. As far as the heart-shaped tip is concerned, I have seen patients who continue to keep the heart-shaped appearance for several weeks post frenectomy, but the tongue should not be otherwise restrained. If, however, you see that the frenum is indeed attached forward in the mouth floor or is still attached anteriorly to the tongue, then it is a structural cause and must be dealt with surgically. If not, then you can proceed to offer exercises to improve the functionality.