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Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 25-28

Phonetic rehabilitation by speech therapy following lingual frenectomy

Department of Public Health Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India

Date of Submission09-Oct-2019
Date of Decision10-Jan-2020
Date of Acceptance28-Mar-2020
Date of Web Publication30-Jun-2020

Correspondence Address:
Dr. Ramya R Iyer
Department of Public Health Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JIHS.JIHS_42_19

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A patient named Miss. Ayesha Saiyad, 18-year-old female, reported to the Department of Public Health Dentistry after undergoing lingual frenectomy for ankyloglossia, in the Department of Periodontics. As she was tutoring school students, she wanted improved clarity of her speech. Through postfrenectomy speech therapy sessions, we aimed to rehabilitate the patient's phonetics and improve her confidence in performing her work. Speech therapy sessions included counseling, motivation for improved speech outcomes and exercises to improve the range of the tongue movements. In the first visit, after recording the chief complaint and speech assessment it was noted that the patient's speech was comprehensible. However, problems were observed during production of speech sounds such as/l/,/ll/,/th/,/tha/ and/r/. The patient was diagnosed with a phonetic articulation disorder. Subsequently, the patient was advised to undergo speech therapy sessions. The counseling session was carried out and tongue protrusion and elevation exercises were demonstrated with the aid of the mirror. The patient was advised to practice the same at home. The patient was recalled after 1 week. Counseling was given and tongue elevation exercise holding water in the tongue was taught to the patient. While exercise and rolling of tongue were taught to improve tongue mobility. There was an improvement in tongue protrusion by 2 mm postspeech therapy. The patient was able to touch the palate with her tongue with mouth open, postspeech therapy. There was improvement in production of speech sounds/l/,/ll/,/th/,/tha/ and/r/. The patient's speech significantly improved after speech therapy.

Keywords: Lingual frenectomy, phonetic rehabilitation, social stigma, speech therapy, tongue exercise

How to cite this article:
Shetty PG, Iyer RR. Phonetic rehabilitation by speech therapy following lingual frenectomy. J Integr Health Sci 2020;8:25-8

How to cite this URL:
Shetty PG, Iyer RR. Phonetic rehabilitation by speech therapy following lingual frenectomy. J Integr Health Sci [serial online] 2020 [cited 2022 Aug 12];8:25-8. Available from: https://www.jihs.in/text.asp?2020/8/1/25/288690

  Introduction Top

The tongue plays a major role in pronouncing the consonants by making contact with specific parts of the oral cavity which are teeth, alveolar ridge, and hard palate.[1] Movement of the tongue, such as, protrusion, elevation and grooving, with a good range of mobility, is pivotal to sound production and flawless phonetics.[2]

  Case Report Top

The patient named Ayesha Saiyad, (case number: 1807090029) 18-year-old female, was diagnosed with ankyloglossia Class III (according to Kotlow's Classification)[3] in the Department of Periodontics and after undergoing lingual frenectomy reported to the Department of Public Health Dentistry for counseling related to speech improvement. She felt that her speech clarity needed to be improved, to pursue her home tuitions more confidently. The principal investigator and her guide had undergone training and observation of the speech therapy patients, with special emphasis on speech improvement in postfrenectomy done on ankyloglossia patients under the guidance of speech pathologist Mr. Vikas Kumar, Assistant Professor Audiology and Speech-Language Pathology, Dhiraj Hospital, Sumandeep Vidyapeeth for 15 days.

The patient expressed that after frenectomy, her speech significantly improved, however, she needed professional help to bring clarity in speech. The chief complaint of the patient was recorded, preliminary speech assessment and tongue movements were examined [Figure 1]. She was motivated to undergo speech therapy including tongue movements which were of significance in phonetics as well as intimacy functions. On preliminary examination, it was noted that the patient's speech was comprehensible. A list of words was prepared in the Hindi language as the patient was comfortable in Hindi. During speech assessment, it was observed that patient replaced the sound/l/and/ll/ with the sound/da/, especially when the sound/l/was at the end of words such as “ladla.” The patient had difficulty in pronunciation of sound/th/ and/tha/ when asked to speak the sentence “Thandi thaili leke aao” and was unable to roll tongue to pronounce the sound/r/as in American accent “river.
Figure 1: Counselling

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The patient was diagnosed with speech sounds disorder precisely phonetic (articulation) disorder with distortion in production of sounds/th/ and/tha/ and substitution of sound/l/ and/la/ according to Bernthal et al.[4] classification of speech disorders. When the patient's maximum tongue protrusion and maximum elevation were assessed, the patient was not able to touch her palate with the tip of the tongue.

In the first speech therapy session, the patient was taught the movements of tongue retraction, tongue protrusion and tongue elevation with the aid of mirror [Figure 2] and lateral movements of the tongue to the right and left corner of the mouth [Figure 3]. The patient was advised to practice the exercise for five times a day.
Figure 2: Demonstration of sound production with the aid of a mirror

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Figure 3: Lateral tongue movement

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After 1 week, the second session was planned for a domiciliary visit; but due to privacy concerns, the patient denied for a domiciliary visit. Hence, the second session was arranged in the Department of Public Health Dentistry, wherein counseling session and assessment of improvement in a speech in pronunciation of sound/th/,/tha/,/l/,/ll/and/r/ were carried out [Figure 4]. The exercise of holding water with the tongue [Figure 5], whistling exercise and rolling of tongue was taught, the patient was advised to practice the exercises every day, and reinforcement was done through telephone once in a week over a period of 1 month. Photographs and videos were taken from the patient after obtaining written consent.
Figure 4: Tongue elevation assessment

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Figure 5: Holding water in the mouth

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At the 1 month recall visit, the speech of the patient had improved and was able to pronounce sound/th/,/tha/,/l/,/ll/ and/r/ with clarity. Unlike the previous visit, the patient was able to touch the palate with her tongue with mouth open [Figure 6] and [Figure 7] and there was an improvement (2 mm) in tongue protrusion from 4.2 mm to 4.4 mm as measured from corner of the mouth to tip of the tongue.
Figure 6: Preoperative tongue elevation

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Figure 7: Postoperative tongue elevation

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  Discussion Top

Major deviations in the articulate structure of sounds change phoneme structure of the sound and are noticed but slight deviations may go unnoticed as speech is still comprehensible.[5]

In the present case, the patient did not have any difficulty in pronunciation of lingua-alveolar (/t/,/d/,/n/) and fricative (/s/and/z/) sounds as they can be produced with very slight tongue elevation and can be generated with little distortion even if the tongue tip is held down. However, the alveolar ridge requires to be elevated in the production of linguo-alveolar sound/l/l/, lingua-palatal sound/r/ and lingua-dental sound/th/ tongue tip.[2] Hence in the present case, the patient had difficulty in the production of those sounds.

It has been recommended by Segal et al.[6] and Steehler et al.[7] that, to improve the mobility of the tongue, the patients have to practice nonspeech oral-motor exercises.[6],[7] Accordingly, favorable outcomes could be appreciated in our patient's phonetics and extent of tongue protrusion and elevation after the patient continuously practiced tongue exercises.

Chinnadurai et al.[8] reported that speech concerns were the second most prevalent outcome described in the ankyloglossia literature. A longitudinal study reported that there is an improvement in articulation after frenectomy treatment, but the benefits of fluent speech warranted phonetic rehabilitation in postfrenectomy patients.[8]

In our study, the patient was unwilling for domiciliary counseling sessions. This reflects on the fact that there could be a stigma attached to undergoing speech therapy. Hence, care should be taken regarding the respect of privacy in speech therapy.[9]

The prognosis of speech therapy for individuals after frenectomy is solely based on the self-interest of an individual.[2] Speech therapy should be an integral part of the treatment plan in patients indicated for lingual frenectomy due to ankyloglossia. Phonetic rehabilitation in this case not only restored speech function but also limited social embarrassment and vocationally rehabilitated the individual.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.


  1. Authors acknowledge the guidance of Dr. Vikas Kumar, Speech Pathologist, Assistant Professor (ENT Department of Audiology and Speech Language Pathology, Dheeraj Hospital, Vadodara) for his guidance
  2. We also thank the Dr. Dhwani Vyas (Periodontist) for timely referral of case for phonetic rehabilitative management
  3. We also thank Faculty of Department of Public Health Dentistry and Department of Periodontics, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, for their support.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Jain CD, Bhaskar DJ, Agali CR, Singh H, Gandhi R. Phonetics in dentistry. Int J Dent Med Res 2014;1:31-7.  Back to cited text no. 1
Sudarsan S, Iyer VH. A comprehensive treatment protocol for lingual frenectomy with combination of lasers and speech therapy: Two case reports. Int J Laser Dent 2015;5:12-21.  Back to cited text no. 2
Kotlow LA. Oral diagnosis of abnormal frenum attachments in neonates and infants: Evaluation and treatment of the maxillary and lingual frenum using the erbium: YAG Laser. M. J Ped Dent Care 2004;10:2004.  Back to cited text no. 3
Bernthal J, Bankson N, Flipsen P. Articulation and Phonological Disorder: Speech Sound Disorder. 7th ed. Boston, MA: Pearson; 2009. p. 8.  Back to cited text no. 4
Ostapiuk B. Tongue mobility in ankyloglossia with regard to articulation. Ann Acad Med Stetin 2006;52 Suppl 3:37-47.  Back to cited text no. 5
Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia: Methodologic review. Can Fam Physician 2007;53:1027-33.  Back to cited text no. 6
Steehler MW, Steehler MK, Harley EH. A retrospective review of frenotomy in neonates and infants with feeding difficulties. Int J Pediatr Otorhinolaryngol 2012;76:1236-40.  Back to cited text no. 7
Chinnadurai S, Francis DO, Epstein RA, Morad A, Kohanim S, McPheeters M. Treatment of ankyloglossia for reasons other than breastfeeding: A systematic review. Pediatrics 2015;135:e1467-74.  Back to cited text no. 8
Cabbage KL, Farquharson K, Iuzzini-Seigel J, Zuk J, Hogan TP. Exploring the overlap between dyslexia and speech sound production deficits. Lang Speech Hear Serv Sch 2018;49:774-86.  Back to cited text no. 9


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]


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