4 year old post frenectomy

Hi: I took the liberty of emailing you as your name was recommended on the ASHA Speech-Language Pathology forum re frenectomy questions….I hope you don’t mind   I have a 4-year old boy who had a frenectomy last week.  Over the past year we have been working on some expressive language issues in addition to articulation.  Mom was uncomfortable with the idea of surgery so we continued to work on articulation for alveolar phonemes and the child is doing quite well and is very intelligible.  Now that he has had the surgery it is apparent that he does not truly dissociate his tongue from his mandible on lateral tongue movements, and has difficulty with voluntary movements such as sticking out his tongue, using his tongue to clean around his lips, etc.  If intelligibility is good – should I really be working on oral-motor movements? I am delighted to offer my opinions, and they are strong and backed by years of experience plus being a founding member of the International Affiliation of Tongue tie Professionals.  I am also on the Board of Examiners and served for many years on the Board of Directors of the International Association of Orofacial Myology.  The reason I mention these is not to toot my horn, but because there are some professionals who make comments or write articles about ankyloglossia who have no background at all or a minimal background that pales in comparison to many of us who have years of training in the area.      Regarding oral motor concepts, I think the reason there has been some negative backlash is because people are practicing oral motor techniques without a sensible plan or sequence for what they are doing.  Some stumble upon exercises that work, some take only bits and pieces from some great folks like Pam Marshalla but don’t follow through completely on what they are directed to do, etc.  I don’t consider what I do as oral motor, but rather that I specialize in orofacial myology.   As an intensive course trainer as well as an SLP, I focus is on orofacial myology with regard to speech issues, and ankyloglossia is one of my favorite areas to teach.       I feel it is our obligation as SLPs to “maximize” lingual function.  Who are we kidding if we pretend that precision has nothing to do with lingual function?   The tongue should be able to move independently of the mandible and lips in order to produce the best possible articulation of sounds.  Because the child is only four years old and because he has a language problem as well, you might not be able to do everything I note in my proficiency exam # 1 in the Myo Manual.  (I don’t know if you have it or not, but I begin by telling what barriers should first be eliminated, what goals should be targeted prior to most every type of therapy and then give exercises to achieve or “maximize” those goals).  Post frenectomy, the goals include being able to move the tongue horizontally (in and out) without assistance of the lower lip or teeth or seeing any lip involvement.  I recommend 2 and 3Way Mouth Props as the tools to keep the mandible stable as the client learns the movement/excursion.  Then the prop is slowly removed.  Also, the client should be able to move from lip corner to lip corner, again without any extraneous mandibular movement.  Again, I use the Mouth Prop as “assistance” until he can do it without the prop.   Then, after making sure he knows the location of the incisive papilla (the spot on the alveolar ridge behind the upper central incisors), you have him work on lingual-mandibular differentiation from that location to a natural dropping of the tongue within the oral cavity.  It should not be a forced release downward and it should not move forward…just naturally falling and rising and falling, to and from the “spot.”   Also on the Myo Manual exam is the section for suctioning flat within the palatal arch, as flat and as well fitting as possible, mouth open widely, maintained for 15 seconds.  That begins the process of improving the lateral borders of the tongue, so necessary for articulatory precision.   The last two sections are too difficult to explain in this email, but if you get him to do the above, you will at the least have given him a good start.  The parts I’m omitting are eventually related to suctioning exercises, which are necessary for best production of CH and J (dj) and other lateralizations.  Suctioning exercises are necessary to improve bolus control as well, but that is a different section of the Myo Manual and he needs to start at the beginning.           I don’t know if your interest extends beyond this, but in case you have more interest in this fabulous specialty area or might even want to be more qualified in it someday, I’ll attach some info including the brochure of upcoming Neo-Health courses.  Keep in touch and let me know if   you need more clarification.  Lastly, you can see some of the exercises that might help you at our www.orofacial myology.com site while watching the videos. https://orofacialmyology.com/myo-media/