Ankyloglossia and palatal expansion, when to do it

Hi, I spoke with you several months ago when I ordered some myo supplies from you. I am a recent COM and a graduate of your short course. I have a frenectomy question. I was recently referred a case where there is an obvious need for a frenectomy, she is 9 and is getting an expander TOMORROW. I need to decide to recommend she get the surgery now and take my chances with the rehab when I basically can’t do much more than mobility work while we wait 4-6 months for the expander to be removed, or wait for the frenum surgery after the expander comes off. Sorry about the long question.

Hi,  I sure wish you could come to the Missouri convention this week because one of the presentations they have asked me to give is on ankyloglossia.  The other is on sucking habits and the scope of orofacial myology.  Did you take any ROM measurements or other measurements on the frenums?  I would have to have an idea of   1. Where is the frenum attached on the tongue  2. Where is it attached on the lower alveolar ridge or floor of the mouth?  3.  With the mouth fully open, what is the distance from the left or right mandibular central incisor to the cutting edge of its mate, the upper rt or left cent incisor? 4.  With tongue on spot, what is that same mearsurement? 5.   If the child can suction well within the palate arch, what is that same distance once again? These are some of the considerations I train people to look at when deciding on surgery.  It sounds from your email that you are pretty certain that the child needs the frenectomy.  If it is that obvious, I would not have the child wait since an ankylosed tongue is not the best thing for palate expansion; in fact, if it had been “clipped” earlier, such at birth, there might not even have been a need for expansion now since the tongue would have filled and shaped the palate all along. Because of the immediacy of this decision, I’m really unable to give the same advice as if I had known about this a few weeks ago.  If she is scheduled for an expander tomorrow, were you thinking of having her cancel her appointment until she has a frenectomy?  If she has the frenectomy, you should be available to work with her as soon as possible afterwards. I know I didn’t directly answer your question, but I can’t do it…Do you have a photo, perhaps?    I hope that by giving you some of this information, it will help you to decide what to do.