SLP with tongue tie and OSA

Hi Sandra, I am a speech pathologist (45 y/o), and have tongue tie, as does my 15 y/o son. We are both considering frenectomy/frenotomy, and my colleague at Idaho State University, suggested I contact you. My son’s interest is primarily cosmetic/comfort. My interest is more concerning: I have a new diagnosis of obstructive sleep apnea (hypopneas, actually), in which the MD believes that the base of tongue is falling into the airway (and per a recent laryngoscopy, my airway is small). When I was a child, an orthodontist offered to clip it, but I wasn’t having any difficulty with speech, and I hadn’t really figured out that my childhood sleep disruption was apnea until all these decades later. I do have a functional dysphagia (primarily with pills, and occasionally other things), but again, nothing really serious that frequently bothers me. If you have a moment, I wonder if you might be able to provide any information/guidance on the following: 1. Adult/adolescent surgery (primarily the cons/downside); and if you think there may be some benefit for either/both of us. 2. Conventional/Clipping vs. laser (pros/cons; which one you might favor). 3. Other considerations that I haven’t thought of! Naturally, if I/we elect to do the frenectomy, this would be followed by a tongue thrust program.  I am fortunate to work with some wonderful SLPs who can give me guidance in this area. (My patients will LOVE that I have a home program!) I have a call in to my dentist, and have just seen the DMD for an oral apnea appliance, but I was hoping to gain a better understanding of how the tonge tie may be impacting my respiration at night (I’ve gained a LOT of awareness of where my tongue is in my mouth these past few months…resting on the mandibular floor, perhaps 1/3-1/2 way back at night), and if is reasonable to hope that some reduction might be made in the apnea (it is on the line b/w mild and moderate; and I’m really hoping an appliance, not CPAP…or dare I hope, nothing at all, after treatment?…may help).  I would sincerely appreciate any thoughts you might be able to share. Thank you in advance for your time

Hi, Thank you for your questions.  Ankyloglossia does appear to have a strong genetic component. You mention your son’s interest is primarily cosmetic/comfort.  When you say “comfort,” that could mean many things.  Is he impinging on the frenum during certain lingual excursions?  In what ways is he uncomfortable?  Many teens won’t tell adults how very self conscious it makes them and that they are concerned about being good “kissers”, etc.  It also interferes with the ability to play certain musical instruments acceptably…and so much more that can affect young adults. With regard to you understandable concern about your own health and sleep pattern:  To my knowledge there are no studies proving a connection between ankyloglossia and obstructive sleep apnea; that, of course, does not mean that there is no connection…but rather that it has not yet been studied and proven. You stated you didn’t have it “clipped” as a child because you weren’t having any difficulty with speech..  I just spoke at our state convention this week and I hope I made them realize that speech is not the main big deal part for us to look at, but rather one of many.  A restricted lingual frenum frequently changes the way one chews and collects the bolus, seals the bolus prior to the swallow, swallows, cleans the oral cavity, naturally massages the gums/gingival tissue to maintain dental health….sometimes it increases the gag to prevent choking on foods; it can be related to certain voice disorders, and so much more.  Adults with a restricted l. frenum have reported feeling “clogged up” during the swallow process, even with something as simple as applesauce. You asked the following questions: 1.   Adult/adolescent surgery (primarily the cons/downside); and if you think there may be some benefit for either/both of us. A:  The only down side would be if you used a professional who was not experienced in releasing frena.  If you find someone who does it often, there should not be a downside.  Post frenectomy problems are extremely rare. Not  doing it offers the bigger downside. 2. Conventional/Clipping vs. laser (pros/cons; which one you might favor). A:  Now this would depend upon a couple of things:  The experience of the person doing the release, as mentioned above, is a big factor.  And…what type of restriction you each have.  If the frenum is “embedded” into the tongue tissue above the area where it attaches to the tongue (called “submucosal”), then laser might not be the choice of the physician.  If it is not embedded, then laser often is the fast, easy, bloodless way to go to release it. The types of lasers and techniques are improving constantly and having the right person who uses the right laser is important. 3. Other considerations that I haven’t thought of! Naturally, if I/we elect to do the frenectomy, this would be followed by a tongue thrust program.  I am fortunate to work with some wonderful SLPs who can give me guidance in this area. A: “Tongue thrust” is but a very minor symptom and might not even been applicable in the case of some patients who have had their frena released.  Also, only a few SLPs are truly trained in this specialty area, although many claim to be; they might not have a clue what to do, skipping basics and jumping into exercises non-sequentially, hoping that something will work.  Sorry to have to say it, but my vast experience and traveling and meeting 1000s of SLPs has proven that to be true.  Unless they have been to some training such as your colleague received, there is no reason to turn your son over to them since you as an SLP could do for him what they could do without having been trained. 4. I have a call in to my dentist, and have just seen the DMD for an oral apnea appliance, but I was hoping to gain a better understanding of how the tonge tie may be impacting my respiration at night (I’ve gained a LOT of awareness of where my tongue is in my mouth these past few months…resting on the mandibular floor, perhaps 1/3-1/2 way back at night), and if is reasonable to hope that some reduction might be made in the apnea (it is on the line b/w mild and moderate; and I’m really hoping an appliance, not CPAP…or dare I hope, nothing at all, after treatment?…may help). A: There are some dental hygienists and non-orthodontist dentists who have made some claims about helping OSA(apnea), but I would be very skeptical and careful about jumping on board quickly.  I can’t promise that release of the tongue tie and a program of orofacial myology will help you, but it only makes sense to maximize your chance for success….and having a restricted lingual frenum released would be the very first thing I would do…for both of you….to give you an even footing. If you can describe and/or send me photos of the following, then I can try to offer even more detailed advice for both of you:

• Where does the frenum insert into the floor of the mouth?  Is it well back or is it near the lower alveolar ridge?  Is it actually “on” the alv ridge and if so, how far up on the ridge?
• Where does the frenum attach onto the tongue itself?  Is it half way, or close to the floor of the mouth, or more anterior on the tongue than halfway?
• Does it appear to enter the tongue in one place, yet have a “pull” that indicates it is also submucosal?
• It is thick?  Thin?  Short (you can estimate in mm)?  Long?  We used to think that the length was the critical factor and also that the presence of a heart shape was the main determinant; both ideas are incorrect.  There is much more than those factors to consider.

I’m putting you into our database so you can have easier access to me as I try to address the questions of my past grads first; then anyone in my database has second priority…. We have  videos that demo several tools at the following link. Click the one for Quick Tongue Tie Assessment tool:  http://www.youtube.co m/oHealthServices