International Journal of Physical Medicine & Rehabilitation
Open Access

Impact of Compensatory Jaw Movements on Articulation Rehabilitation in Ankyloglossia

Maryam Sahl^{* *}Correspondence: Maryam Sahl, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, USA, Email:

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Description

Articulation rehabilitation in severe ankyloglossia represents a vital component of functional management that extends well beyond the correction of anatomical restriction. Ankyloglossia, commonly known as tongue-tie, is defined by an abnormally short, thick, or inelastic lingual frenulum that limits the tongue’s range of motion. In severe cases, this restriction affects the tongue’s ability to elevate, protrude, and lateralize, all of which are essential for accurate speech production. While the physical limitation is apparent, the resulting speech impairments are often complex and multifactorial, shaped by years of compensatory behavior and altered neuromotor development. Articulation rehabilitation addresses these deeper functional consequences, aiming to restore clarity, efficiency, and naturalness to speech. Severe ankyloglossia disrupts typical speech development by interfering with the precise tongue placements required for consonant production. Sounds that depend on fine lingual contact with the alveolar ridge, palate, or teeth are particularly vulnerable. Faced with restricted movement, individuals often develop alternative strategies to approximate target sounds. These strategies may include excessive jaw movement, lip substitution, posterior tongue elevation, or increased muscular tension throughout the oral mechanism. Although these adaptations may allow communication to occur, they often result in distorted articulation, reduced intelligibility, and increased effort during speech.

The persistence of articulation difficulties in severe ankyloglossia highlights the limitations of relying solely on surgical intervention. Procedures such as frenotomy or frenuloplasty can release the physical restriction and expand the tongue’s potential range of motion, but they do not automatically correct the learned patterns that govern speech. Individuals who have relied on compensatory strategies for years may continue to use them even after surgical release. Articulation rehabilitation serves as the functional counterpart to anatomical correction, guiding the individual in discovering and utilizing newly available movements for accurate speech production. A foundational aspect of articulation rehabilitation is increasing awareness of tongue movement and placement. Many individuals with severe ankyloglossia lack precise proprioceptive awareness of the tongue, having experienced limited movement throughout development. Therapy focuses on helping individuals consciously perceive where the tongue is in space and how it contacts oral structures during speech. This awareness is essential for modifying articulation patterns, as accurate placement cannot be achieved without reliable internal feedback. Through guided practice and repetition, individuals begin to develop a clearer sense of correct versus compensatory movement. 

Resting tongue posture plays a significant role in articulation rehabilitation. A chronically restricted tongue often assumes a low resting position within the oral cavity, influencing muscle tone and movement patterns during speech. This low posture can perpetuate imprecise articulation and increase reliance on surrounding musculature for stability. Rehabilitation addresses this by encouraging a relaxed, elevated resting posture of the tongue against the palate. Establishing an appropriate resting position provides a stable starting point for speech movements and promotes more efficient articulatory transitions. Articulation rehabilitation in severe ankyloglossia also emphasizes the separation of tongue movement from excessive jaw involvement. When tongue mobility is limited, the jaw frequently compensates by moving excessively to assist with sound production. This coupling reduces articulatory precision and can contribute to fatigue and discomfort. Therapeutic strategies focus on stabilizing the jaw while training the tongue to move independently. As dissociation improves, speech movements become more refined, allowing for clearer sound production with less overall effort.