# The Effectiveness of Frenotomy on Speech in Adults
## 1 Introduction  
Tongue-tie (TT) or ankyloglossia represents a condition in which the tongue's movements are limited due to the lingual fronulum's length. If the fronulum is too short, it tethers the tongue. Lingual fronotomy is a surgical procedure that should be implemented in most cases. Searching through medical databases such as PubMed, it is surprising that there is no publication concerning TT in adults. It is generally known that ankyloglossia is mainly diagnosed in newborns and infants. In this field, there are several publications and grading scales such as 1993 [PERSON]'s [1], 1999 [PERSON]'s [2], or 2009 [PERSON] [3] classification of ankyloglossia in children [4]. Moreover, there are detailed descriptions of the prior and aftercare of patients. Besides, there is insufficient information about TT's influence on adults' speech production and generally oral functions. It seems unlikely that ankyloglossia does not cause functional disorders in adults, especially considering that this form of ankyloglossia has been present in adults since childhood. Little is known about the anatomy, and even in anatomy textbooks designed for medical universities, the lingual fronulum is only briefly described. It is not easy to find articles giving full consideration of the fronum's anatomicalstructure, relationship to the floor of the mouth, and detailed descriptions of surgical procedures in adults [5]. As mentioned before, tongue-tie is generally diagnosed in children. Most classifications and anatomical descriptions consider the frenulum correct when it is visible or palpable [6] and does not limit the tongue's mobility [7]. Most classifications such as [PERSON]'s, [PERSON]'s, or Corryllos\({}^{\prime}\) use only a single feature of lingual frenum\({}^{\prime}\)s visual appearance and categorize the tongue-tie grades (Table 1). To briefly introduce classification, it is essential to describe the primary grades. The anterior tongue-tie is an attachment placed close to the tip of the tongue, while the posterior tongue-tie describes a frenum with a ventral tongue attachment; it is impossible to see it, as it is submucosal and needs to be palpated. What is more, in posterior TT, there is no visible tension [8]. In [PERSON]'s opinion, classes III and IV should be given special care as they severely restrict tongue range of movements. [PERSON] also shares his criteria of the normal frenulum and its functionality as follows: the tip of the tongue should be able to protrude outside the mouth; without clefting, the tip of the tongue should be able to sweep the upper and lower lips easily; without straining, when the tongue is retruded, it should not blanch the lingual tissues to the anterior teeth, and the lingual frenum should not create a diastema between the mandibular central incisors [9]. On the other hand, [PERSON]'s assessment considers the appearance of the tongue accompanied by functions. However, this tool's great weakness in comparison with [PERSON]\({}^{\prime}\)s or [PERSON]\({}^{\prime}\) is that it was designed for newborns and infants, and it is tough to transform this kind of assessment into adults. The multitude of classifications may create a dilemma when the frenulum should be considered normal or abnormal. Due to this fact, during the last decade, there has been a high increase in diagnosing TT worldwide [10]. Moreover, TT significantly impacts primary functions such as mastication, swallowing patterns, speech, and malocclusion, which should be carefully examined and considered before deciding frenotomy. Speech impairments and articulation disorders are observed frequently in children with TT. Interdental lisping, hotacism, multiple dyslalias [11], and any speech delay variation are mainly linked to humans\({}^{\prime}\) anatomical defects, altogether with weak mobility and motor skills [12]. Similar disorders can be observed in adults. The worldwide higher percentage of misarticulation is detected in rhotacism, and misarticulation of /R/ is mainly caused by a too-short frenulum in almost every language.