Dyslalia ankyloglosyjna. O krótkim wędzidełku języka, wadliwej wymowie i skuteczności terapii

Data udostępnienia wersji cyfrowej na licencji CC-BY-SA: styczeń 2026

ANKYLOGLOSSIC DYSLALIA. ON THE SHORT FRENULUM OF THE TONGUE, PRONUNCIATION, AND THE EFFICACY OF TREATMENT

The monograph presents the results of studies on the sound realizations of consonantal phonemes of Polish in 210 patients with the short frenulum of the tongue (ankyloglossia) and changes in the quality of simple (non-articulatory) and complex (articulatory) tongue movements in the surgical-logopedic treatment, which I conducted under the supervision of Professor Bronisław Rocławski from 1995 to 1999.

under the supervision of Professor Bronisław Rocławski from 1995 to 1999. The short frenulum of the tongue became the subject of my studies when I read in one of the publications intended for speech therapists that “the tongue frenulum has no influence whatever on tongue mobility and pronunciation”, and that “the surgical procedure is pointless and does not facilitate speech development”. As a speech therapy practitioner I was convinced that the short frenulum kept the tongue “captive” at the bottom of the mouth and it was impossible to lift it to the front part of the palate, even in a speech therapy treatment. The survey of scanty Polish and foreign medical and logopedic literature showed that different opinions on ankyloglossia were far apart while the treatment of ankyloglossia, practiced in the world for at least three thousand years, was regarded in the mid-twentieth century as unnecessary and ineffective, although neither ankyloglossia nor its influence on the quality of pronunciation, nor the results of surgical treatment were studied in detail. The descriptions of pronunciation quality (of few or single cases) presented in literature by the opponents and (few) advocates of cutting the tongue frenulum, are generalized and perfunctory, being based on an important but unilateral criterion for speech intelligibility, which permits one to ignore its phonetic defects (distortions). Phonemic deficiencies (substitutions and elisions) are in turn classified as developmental phenomena, of which most children “grow out” (after the age of seven they are rare occurrences), therefore the belief that ankyloglossia is not the cause of speech impediments may seem justified.

My research has shown that regardless of their age all the subjects with ankyloglossia realize some of the consonantal Polish phonemes in a defective way, and the relationship between the (negligible, moderate, severe) limitation of non-articulatory and articulatory tongue mobility is statistically significant for the majority of the phonemes. Defective realizations affect alveolar phonemes (in particular /r/), dental ones (especially dentalized phonemes), palatal phonemes, and, from the fourth year of deficiencies are equally frequent among patients who underwent prior speech therapy treatment and those who did not, which means that tongue exercises – the foundation of treatment – do not lengthen (expand) the frenulum as needed. The monograph presents changes in tongue mobility (including photographic documentation) after 152 procedures of frenotomy in 95 subjects, which show that surgical treatment of ankyloglossia was recognized too hastily as ineffective. This view may have developed as a result of the implicit assumption that one procedure enables verification of the advisability of performing it: if it does not eliminate ankyloglossia, it is ineffective. My studies show that each horizontal cutting of the frenulum with scissors (less often with a scalpel) under local anesthesia without suturing the wound after incision improves tongue mobility, but usually only partially; to obtain the full mobility of the tongue more procedures are required. The finding that frenotomy is an effective although usually a multi-stage method of surgical treatment of ankyloglossia would not have been possible without the photographic documentation, which made it possible to reveal that performing the next procedure was justified. The documentation also challenges the prevailing belief about adverse post-surgical adhesions, which are referred to as an argument against the surgical treatment of ankyloglossia. Some of the incorrect articulation positions and tongue movements disappear spontaneously after the procedure, some are eliminated in a speech therapy treatment; the achievement of the desired tongue positions and movements after frenotomy depends on progress in the treatment of ankyloglossia – total articulation improvement is achieved by patients who complete treatment.

My pioneering studies into ankyloglossia, the dysfunction of the tongue in articulation, and changes in the surgical-speech therapy treatment of ankyloglossic dyslalia are an introduction to achieving a thorough knowledge on the influence of ankyloglossia on all activities performed with the participation of the multifunctional tongue. Further logopedic research problems that follow from them, inter alia the influence of ankyloglossia on the position, movements, and function of laryngeal structures versus phonatory difficulties in ankyloglossia patients; the influence of ankyloglossia on the abnormal, anterior position of the tongue in the mouth versus, possibly seeming, macroglossia in Down patients; the influence of ankyloglossia on the tongue position at rest versus the co-occurrence of malocclusion with a speech defect, all these require further interdisciplinary studies.

Translated by Jerzy Adamko