1. Speech Improves After Frenuloplasty in Children With Ankyloglossia
Yasuo, Ito1) Toshimitsu Shimizu 2),
Tomomi Nakamura 2), Chie Takatama 2)
Division of Pediatric Surgery 1)
and Division of Speech Therapy 2)
International University of Health and Welfare
Atami Hospital, Japan

2. Ankyloglossia Presenting symptoms： Latching problems 20 patients
Thirty one patients with ankyloglossia visited our clinic from September 2010 through August 2012.
Presenting symptoms：
Latching problems patients
Speech problems patients
Tongue deformity patients

3. Subjects and Methods
Five children with speech problems were evaluated for their misarticulations before and after frenuloplasty.
Severity of ankyloglossia was assessed by an assessment score for children over 1 year old. (modified from the Hezelbaker assessment tool )

4. Assessment score for ankyloglossia in children over 1 year old.
1) Attachment of lingual frenulum to tongue
2: > 1 cm from tip
1: > 6 mm and < 1 cm from tip
0: < 5 mm from tip
2) Attachment of lingual frenulum to oral floor
2: Attached to floor of mouth
1: Attached to lower ridge
0: Attached to upper ridge
3) Appearance of tongue when protruded
2: Round
1: Slight cleft in tip
0: Heart-shaped
4) Extension of tongue
2: Tip over upper lip
1: Tip over lower lip
0: Neither of the above
5) Speech for age
2: not disturbed
1: a little disturbed
0: markedly disturbed
Total score：
1-3: Appearance scores.　
4 and 5: Functional scores

5. Details of patients who underwent surgery for articulation disorders.
Age
(y/o)
Sex
Severity
score
　　　　　　　 History
Operation 1 5
male ５
Attending speech training class, Inherited
frenuloplasty 2 8
female ７
Attending speech training class
Fren uloplasty 3 ６
Pointed out by a nursery teacher 4 ４
Pointed out by a local physician
frenotomy 6

6. Articulation test (1)
(From the guidelines of Japan Society of Logopedics and Phoniatrics)
Speech articulation test consists of 50 pictures of common Japanese words with 2-3 syllables.
Patients were asked to pronounce what the picture card showed.

7. Articulation test (2)
Word production accuracy and intelligibility were assessed by counting the number of errors.
Misarticulations of substitution, omission, and distortion were checked using international phonetic alphabets on a test sheet.

8. Types of misarticulation
Definition of Misarticulation
　Example　
Substitution
Replacement of a sound with another sound
“wed” for “red, “dut,” for “duck”
Omission
No production of a sound in a word
“pay ” for “play”
Distortion
Production of a sound in an unfamiliar manner (non-typical sound)
“pencil” (nasalized p sound more like “m”encil),
ｌａｔｅｒａｌ “s” sound

9. Postoperative evaluation
Number of substitutions and the sounds expressed
according to international phonetic alphabets.
Patient
Preoperative evaluation
Postoperative evaluation
1 month
3-4 months
1-2 years 1
3 (s, dz, ts)
0 (-)
0 (- ) - 2 3
6 (k, g, ɲ, ŋ, ʧ, gj)
3 (k,g,ŋ)
1 (k)
1 (s) 4
5 (s, ʤ, ts, ʃ, ɾ)
4 (s, ts, ʃ, ɾ) 5
5 (s, dz, ts, ʃ, ɾ)
2 (ʃ, ɾ)
2 (d, ɾ)
Total 19 10 7

10. Number of substitutions before and
after frenuloplasty

11. Postoperative evaluation
Number of omissions and the sounds expressed according to international phonetic alphabets
Patient
Preoperative evaluation
Postoperative evaluation
1 month
3-4 months
1-2 years 1
1 (ɾ)
0 (-) - 2 3 4
2 (t, ɾ )
1 (t) 5
Total

12. Postoperative evaluation
Number of distortions and the sounds expressed according to international phonetic alphabets.
Patient
Preoperative
evaluation
Postoperative evaluation
1 month
3-4 months
1-2 years 1
2 (s, ɾ)
0 (-) - 2
3 (ʧ, ʤ, ʃ)
2 (ʧ, s)
8 (ki, kjm, gi, ɲi, ʃi, ʧo, ʧi, ri) 3
5 (s, ʧ, dz, ts, ɾ)
4 (dz, s, ɾ, k)
4 (dz, ts, s, ɾ) 4
1 (ɾ) 5
2 (ki, gi)
2 (ki, çi )
1 (ki)
1 (ʧi)
Total 13 9 8 11

13. Number of distortions before and after frenuloplasty

14. Summary of Misarticulations before and after frenuloplasty
Type
Preoperation
No. of Cases
(No. of Errors)
Postoperation
1 month
3-4 months
1-2 years
Substitution
4　 (19)
3　(10)
3　 (7)
1 (1)
Omission
4　 (5)
3　 (3)
2　 (2)
１ (1)
Distorsion
5　 (13)
4　 (9)
4 　 (8)
3 (11)

15. Operative Outcomes of Speech Disorders Associated Wth Ankyloglossia
Author
（year）
No. of cases
Operative method
　　　Improvement ratio
（assessment method, follow-up period）
Ito S
(1988) 13
Not described
84.6％ 　(11/13)
(articulation test, 2 weeks-7months)
Messner AH
(2002) 11
horizontal-to-vertical (H-V) frenuloplasty
82％　 (9/11 )
score （5 points maximum） 3.4 → 4.2　
（ｐ<0.01)
（parent questionnaires, 3-6 months)
Heller J
(2005) 16
z-frenuloplasty
11cases
H-V frenuloplasty
5 cases
z-frenuloplasty : improvement >2 grades 91% (No improvement 9%)
H-V frenuloplasty: improvement of 1 grade 40% (No improvement 60%)　　　
（4 grade scale, >10 months)

16. Conclusions
Articulation disorders in children with ankyloglossia were improved by frenuloplasty.
Phonetical and philological studies were effective to evaluate articulation disorders.
Substitution and omission improved relatively early after frenuloplasty and progressed to distortion.
The number of distortions did not significantly decrease and tended to remain a defective speaking habit.
Postoperative speech training by a speech pathologist would be necessary for older patients who acquire abnormal speaking habits.