# The Effectiveness of Frenotomy on Speech in Adults
## 2 Materials and Methods  
The presented study focused on the description of the impact of tongue-tie on primary functions, tongue's range of motion, and speech in the population of Polish adults, who also suffer from different severity of the malocclusion, and was approved by bioethical committee RNN/73/19/KE. The research group consisted of 75 patients, Caucasian race, male (\(n=28\)) and females (\(n=47\)), with an average age of 24. Inclusion criteria: tongue-tie of any degree, Class II and III malocclusions, age > 18, no previous surgical treatment of lingual fronulum, and generally healthy. Exclusion criteria: patients did not sign the informed consent, any previous surgical treatment of lingual fronulum, lack of Class II and III malocclusion, or the patient did not obey the rehabilitation protocol (did not attend examinations or exercise according to recommendations). Examiners were as follows: speech therapist, who conducted the full TT and logopaedics diagnostics, and maxillofacial surgeons, who conducted fronotomy. All of the patients were diagnosed with TT of different severity according to [PERSON]'s classification: 26 patients were diagnosed with mild ankyloglossia, 24 with moderate, and 25 with severe, and there were none with complete ankyloglossia. Out of 75 patients, 40 underwent a fronotomy. The surgical procedure was a horizontal incision, using a scalpel, without sewing, with local anesthesia by 4% Articain + Adrenaline. All of the patients qualified for TT's surgical treatment were doing some exercises before and after the surgery to gain the best possible mobility of the tongue, surrounding tissues, and muscles. Those exercises included: gentle massage of the mouth's floor along with the fronulum itself (using the index finger), horizontal and vertical movements of the apex, preadorsum, mediodorsum, and postdorsum. Vertical movements of the mediodorsum are movements in which the middle part of the tongue moves upward to the palate, and the tip is placed close to the upper central incisors. Postdorsum movements are performed while coughing and moving the soft palate. Due to such movements, patients could identify the tongue's location and particular muscles after the fronotomy. Besides, they were instructed to open their mouth wide so as not to feel any discomfort. Patients were asked to do some basic physical activities of the whole body like stretches facing down and neck rotations, accompanied by the massage of glottal and subglottal muscles. During the essential intraoral examination, the assessment included: fronulum length according to [PERSON]'s classification, tongue shape, the look of the dorsum surface and its resting position, type of occlusion, teeth position, missing teeth, crowding, and other dental disorders, the shape of dental arches, palate, and lips, breathing, swallowing, biting, and chewing types, and pace of speech and its fluency. Breathing was observed during the whole examination, patients were also asked to do some exercises like squats, and it was checked whether the lips are sealed during physical activity and how they deal with inhales and exhales during the speech. To examine swallowing, biting, and chewing, patients were asked to drink water and eat an apple. Factors determining the proper function of swallowing were no or minimal activity of the mimic muscles and proper tongue's position (upward and backward movement of the tongue). For chewing, it was essential to observe jaws and lips' movement during the action and the lips' seal. When examining biting, it was crucial to check if the patients use their central incisors or is the act of biting moved laterally. Also, during the intraoral examination, the speech therapist looked at the tonsils and using the Pirquet's scale, assessed the size of tonsils. The motor assessment of tongue and lips was based on the adaptation of the Speech Organ Fitness Questionnaire [13], in which 20 tests were provided to assess both tongue and lips' motor skills. Table 2 presents the tests' descriptions.