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Frenectomy


Question

Is there a benefit to a child with CdLS getting a frenectomy? Our speech pathologist has recommended this.

Answer of our experts

My experience has been that individuals who are very familiar with cleft palate are more knowledgeable about speech and oral-motor functioning than are other professionals. A slight regression would not surprise me, knowing how other similar events affect children with CdLS. I only have general knowledge in the area of recuperation, but I suspect it would be a somewhat short recuperation period, probably under a week. The oral cavity (mouth and associated structures) is very highly innervated and tends to heal quickly

Inform his present speech therapists about the procedure. They will probably monitor the range of his tongue movements by listening to and watching how he articulates sounds such as "th, k, g" and "-ing." MG-Speech/TK 7-13-10

I would recommend treating it. General anesthesia would be the best way to go because it will immobilize the patient and the surgeon can focus on the procedure and obtain a more therapeutic result, as opposed to concentrating on both the sedation and the procedure. Also, any other dental work that needs to be done, such as sealants and restorations or extractions if necessary, can be completed at the same time. After healing, consider seeing a myofacial therapist for tongue therapy in conjunction with his present speech therapist. I do agree that his speech probably will improve with effective frenectomy treatment and myofacial therapy as well as with continued speech therapy. I would request a pediatric anesthesiologist. Any other elective procedures may also be able to be scheduled at the same time

DC-Dental /TK 7-13-10

I totally agree with DC regarding the frenectomy. It should be done under general anesthesia and in a pediatric institution or with a pediatric anesthesiologist. The recovery is usually very rapid and should not alter speech patterns. The tongue will behave in its usual manner until exercises are instituted that will help "teach" it to move in the proper directions for appropriate articulation

When I perform this surgery, I use a carbon dioxide laser. The only advantage is that there is no bleeding and no post-operative discomfort. This information should not muddy the question at hand, though. Before I ever consider a frenectomy, I always refer to the speech pathologist first. If he or she feels that they have reached the extent of their therapeutic progress and a structural change is needed for further success, then I perform the surgery upon their request. If speech therapy alone can accomplish proper speech, I prefer not to intervene with surgery. It is best to be conservative, but the final decision rests with the myofunctional therapist or speech pathologist

DM-Dental/TK 7-13-10

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Recommendation(s)

Mouth, nose and throat

R42
The anaesthesiologist should be aware of the potential difficulty with intubation in individuals with CdLS.

Recommendation(s)

Communication and language

R63
When assessing communication, vision and hearing problems, speech impairments, intellectual disability, difficulties in social interaction and social anxiety should be considered. Video observations can be very useful.
R64
Developmentally appropriate communication strategies (such as speech therapy, augmented communication input) should be implemented within the first 18 months of life.

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