What is the lower jaw lingual frenum
Dysglosia Symptoms, Causes, and Treatments
The Disglosy is a disorder of the articulation of the phonemes due to malformations or anatomical and / or physiological changes in the peripheral articulatory organs.
All of this hinders the linguistic functioning of people without recognizable neurological or sensory affectations.
Etiology of dysglossia
The causes that can lead to the dysglossia are congenital craniofacial malformations, stunted growth, peripheral paralysis, and / or acquired abnormalities from the injury or excisions of the orofacial structure.
There are three aspects that can be related to dysglossia. However, we must consider these aspects are not a direct cause of diglossia, although this will worsen the picture, as the person concerned has difficultyna using compensatory mechanisms to improve spontaneous speech instead.
These aspects are:
a) The mental retardation to varying degreesVery strong on syndromes that affect the craniofacial structure.
b) The psychosocial deprivation derived from the physical aspect and the physiological difficulties derived from the anatomical changes.
c) The Hearing loss as a result of an inadequate structure or changes in the organs of hearing for a particular syndrome.
These aspects interfere with the course of treatment and prevent the individual from improving as expected.
Among the symptoms of dysglossia, we can distinguish on the one hand the core symptoms and on the other hand the associated symptomatology.
a) Nuclear symptoms
The central symptomatology is characterized by a change in the articulation of the various phonemes, anatomical malformations of peripheral organs and central language of no neurological origin.
b) Associated symptomatology
Symptoms associated with dysglossia are the presence of rhinophonia, that is, changes in voice that result from lesions in the resonance cavities.
In addition, we find psychological disorders that are consistent with the language problem, such as the person with this disorder refusing to speak.
In addition, this condition can be associated with delayed schooling, reading difficulties, difficulty in normal flow of speech, hearing loss (particularly cleft palate), and other difficulties associated with long hospital stays.
In addition, we also found a lack of adequate stimulation levels of development and the mistaken belief that diglossia is inevitably associated with mental retardation.
Classification of the disglosies and main features
1- lip dysglossia
Lip dysglossias are a disorder of the articulation of phonemes due to changes in the shape, mobility, thickness, or consistency of the lips.
Those that are more common are due to:
a) Cleft lip: It is a congenital abnormality that ranges from the simple depression of the lip to its total cleft.
The malformation can be unilateral or bilateral, depending on the affected side. The cleft lip can be unilateral or bilateral and simple or total.
The most severe form of this malformation is known as the middle or central cleft lip.
b) Hypertrophic upper lip frenulum: The membrane between the upper lip and the incisors is developing too much. You have difficulty articulating the phonemes / p, / b /, / m /, / u /.
c) Torn lower lip: Gap in the lower lip.
d) Facial paralysisOften a consequence of the forceps, which causes injuries and abnormalities in the middle ear. You have difficulty speaking the phonemes / f /, / n /, / or /, / u /.
e) Macrostomy: Lengthening of the cleft cheek, which can be associated with malformations in the ear.
f) Lip injuries: some sores in the lip area that could cause changes in the pronunciation of the phonemes.
G) Trigeminal neuralgia: Sudden and short-lived pain that appears in the eye area, upper and lower jaw on the face.
2- Mandibular dysglossia
Mandibular diglossia involves changing the articulation of phonemes made by changing the shape of one or both of the jaws.
The most common causes are:
a) Maxillary resection: the upper jaw separates from the lower jaw.
b) Mandibular atresia: Anomaly jaw caused by developmental arrest congenital (endocrine disorders, rickets, etc.) or acquired (use pacifier, thumb sucking, etc.), which ends up producing jaw deformity there.
c) Maxillofacial dysostosis: It is a rare hereditary disease that is characterized by mandibular malformations derived from other anomalies in the typical appearance of "fish face".
d) Offspring: Growth of the lower jaw causing jaw misalignment.
Change in the shape and position of teeth due to heredity, hormonal imbalances, feeding, orthodontics, or dentures.
4- Lingual dysglossias
It is characterized by the change in the articulation of phonemes due to an organic perturbation of the tongue that affects the speed, accuracy and synchronization of the movements of the tongue.
The most common causes are:
a) Ankyloglossia, or short frenulum: The membrane under the tongue is shorter than normal.
b) Glossectomy: complete or partial extirpation of the tongue.
c) Macroglossia: excessive size of the tongue causing breathing problems (characteristic of Down syndrome).
d) Congenital malformations of the tongue: Arrest in embryonic development.
e) Microglossy: Minimum size of the language.
f) Paralysis of the hypoglossus: when the tongue cannot move and there are problems speaking and chewing. It can be bilateral or unilateral.
5- Palatal dyslexia
It is a change in the articulation of phonemes caused by organic changes in the bony palate and the soft palate.
The pathologies in which the normal structure is affected are called:
a) Cleft palateCongenital malformation of the two sides of the palate, which severely impair swallowing and speaking.
The cleft lip or palatine comes from the first few weeks of pregnancy.
b) Submucosal fissure: Malformation where the palate is split.
To begin assessing dysglossia, it is advisable to take a medical history so that you can know:
- The reason for the rating.
- Family history
- Pregnancy and childbirth
- Psychomotor development
- The development of language.
- The development of the dentition.
- The food
- Breathing (diurnal and nocturnal - presence or not snoring).
- Adenoid problems, in the tonsils, rhinitis and otitis.
- Use of pacifier, drooling, lip, digital, cheek, tongue, objects, bite objects, etc.
- Hospital stays, surgical interventions and relevant illnesses.
Then we will move on to the comprehensive assessment of the Bucco organs:
Observe the resting lips: we have to indicate whether they are closed, half open or wide open.
- Also We have to take care of the form knowing about them whether they are symmetrical or asymmetrical, the shape of the upper and lower lip, which indicates whether it is short, normal or long, and the presence of scars, as well as their location and characteristics.
- The Lip mobility It is assessed by asking the child to move their lips to the sides, project them, stretch them, make them vibrate, and fold them as if to kiss. We will record when the lips move normally, with difficulty, or without movement.
- Tonicity: We will observe the labial tone by practicing the kiss and we will touch the upper and lower lip with the finger to notice the resistance of the same and we will call it normotension, hypertension or hypotension.
- Lip frenum: Through observation we will judge whether the lower or upper lip frenulum is short and the upper lip frenulum is hypertrophic.
- We will watch the tongue calmly and we shall see if it lies on the hard palate, is placed between the dental arches, presses the arches sideways, or projects onto the upper or lower arch.
- shape: We ask the child to stick their tongue out and we take care of the shape that the language presents, it can be normal, microglossia / macroglossia, wide / narrow and voluminous. It is important that we check to see if there are any side marks on the teeth.
- mobility: The child is asked to move the tongue to the sides, lift it, project it, make it vibrate, etc. So we will evaluate whether it moves normally, with difficulty or without movement.
- TonicityTo see the tone of the tongue, we use a tongue depressor and press the tip of the tongue while the child resists. Through this examination, we can determine whether the language is normotonic, hypertonic, or hypotonic.
- Lingual frenulum: We ask the child to raise the language to check his form. If it is difficult, we ask that you suck your tongue against the hard roof of your mouth and hold it. This allows us to observe whether the lingual frenum is normal, short or not very elastic.
- shape: When looking at the palate, we should look at the shape it represents, it can be normal, large, pointed, wide or narrow, flat, short, with scars.
- Palatine folds: Observe whether the folds of the hard palate are normal or hypertrophic.
- We observe the soft palate at the end of the oral cavity. One of the items that we need to take care of is the uvula. When we observe it, we need to indicate whether it has a forked structure, or whether it is long, short, or absent.
- We need to determine the presence of scars or fistulas on the white palate.
- We will watch its dimensionwhether it has a conventional dimension or is shorter than expected.
- mobility: In order to be able to observe the mobility of this area of the bucofonador device, we must ask the individual to give the phoneme / a / during the exploration. In this way we can see whether mobility is good, reduced or absent.
- Dental / jaw arches: Observe whether the dentition is temporary, mixed, or permanent.
- Pay attention to the lack of pieces of teeth.
- See if there is any separation in the teethwhere and how you can influence the language.
- Malformation of dental pieces.
- Indicate if you have dentures, fixed or removable.
- Condition of the gums: normal, inflamed or bleeding.
- How is the bite of the person?.
- Ability to open your mouth: difficult, does not open, dislocates the jaw, etc.
- Observe if there is any frontal symmetry between the right and left sides of the face.
- Facial profile: normal, retrusive or forward projection of the jaw.
Another relevant aspect for dysglossia is the assessment of orofacial functions. For this we have to participate:
Observe whether breathing is nasal, buccal, or mixed when there is breathing coordination. In addition, it is important to evaluate breath control and measure lung capacity.
To assess the swallowing process, the individual is offered water or yogurt and we observe the placement of the lips, tongue and the pressure that is applied to swallow the food.
In order to evaluate the chewing, the test person is offered a kind of donut or biscuit and the movements that are made with the mouth and tongue are evaluated.
It is important to pay attention to the tone of voice, the existence or non-existence of hypernasality, and the existence of difficulties in articulation.
As mentioned earlier, people with dysglossia can have hearing problems, so assessing the ability to hear discrimination is also important.
For this we will take care of the following:
Auditory distinction of sounds
Sounds of everyday objects are presented and asked to identify them. For example, tones of coins or a crumpled paper.
Auditory word discrimination
Words with similar phonemes are presented and the person must identify the difference.
In treating dysglossia, it is important that multidisciplinary intervention is conducted given the nature and character of this language disorder.
Since Dislloisa is a disorder that affects different areas of the individual, through the coordination of a team of professionals we can achieve that the patient can achieve normative development.
The professionals who would integrate this multidisciplinary team would be:
- Neonatologist: is the first professional with whom the child contacts and with whom the treatment begins.
This professional will perform a quick assessment of neonatal growth and development. He makes an assessment of the anomaly or deformity identified and can thus determine the best way to feed and mobilize the available resources for the child to be served by the team.
- Pediatrician: is the one who will follow up, is the professional who has direct contact with the parents and who has the mission to inform and accompany during the treatment.
In addition, you need to be in touch with the other members of the multidisciplinary team.
- orthodontist: It is the professional who is responsible for correcting correct dentition, the accommodation of the palate and the parts of the teeth, initially and during the development of the treatment.
- Speech therapist: Specialist who treats the functional part of the first part of the digestive and respiratory systems. The aim is for the individual to achieve a correct phonation function.
- psychologist: This professional will work with the parents and with the child.
On the one hand, the work is focused on the parents first in an attempt to alleviate the pain they experience from the deformity and treatment of their child.
On the other hand, the psychologist will work directly with the child to achieve normalized social integration and adequate self-esteem.
- surgeon: coordinates the treatment, explains, supports and sends the child for consultation and integration of the treatment until the surgical correction is made. It is convenient to start surgical treatment during childhood so that the oral organs that are being changed can be repaired before speaking.
Operations are likely to be repeated if the patient is an adult.
- OtherProfessionals: Social workers, aesthetic surgeons, ENT doctors, anesthetists, etc.
And you, did you know about dysglossia?
- Belloch, A., Sandín, B. and Ramos, F. (2011). Manual of Psychopathology (Volumes 1 and 2) McGraw-Hill: Madrid.
- Díaz, A. (2011). Difficulty acquiring language. Innovation and educational experiences 39.
- Soto, M.P. (2009). Language assessment in a student with dysglossia. Innovation and educational experiences 15.
- Prieto, M.A. (2010). Changes in Language Acquisition Innovation and educational experiences 36.
- De los Santos, M. (2009). The disglosies. Innovation and educational experiences 15.
- Protocol for the evaluation of dysglossia. Lea group.
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