黐脷根(Tongue Tie)和語言發展遲緩的關係?

lycheema

其實黐脷根(tongue Tie,  ankyloglossia) 會否影響兒童語言發展遲緩, 現時在醫學界仍有爭論. 而小兒有輕微黐脷根, 在看過了耳鼻喉科醫生和言語治療師後, 我再上過超過30 websites, 看過超過100篇中英文章, 我不相信耳鼻喉科醫生和言語治療師的意見, 因為我發覺在這專題上, 他們並沒有足夠資料,書本上的知識可能已是過時了.

我傾向是有影響小兒遲說話,說話吃力和發音不正(Difficulty making (articulating) the t, d, z, s, th, n, and l sounds as your young child learns to speak.) (The most common is Ws as Ls; for example the word "lemonade" would come out as "wemonade.")

在上網找Tongue Tie資料的同時, 竟意外發現老爺和先生都有輕微黐脷根, 而我先生竟告訴我他說中, 英文都感"吃力"(他是跨國企業的中層), 他說講說話令他舌頭很倦, 他竟同意了他自己都做手術.

有文章話:

倘若舌繫帶較短，那舌頭的活動就會受到影響了，這就好像小狗脖子上的狗鏈若很短，那狗狗一定是不能到處亂跑的。這種情形，醫學上稱之為「舌繫帶縮短症」。

現在我先生要放狗鏈, 小兒又如何呢?可惜anesthesia 有機會令小朋友(小兒未滿4歲)腦細胞死亡(
http://www.foxnews.com/wires/2007Mar29/0,4670,ChildrenAnesthesia,00.html
), 真是仍需考慮....我會再找醫生傾.

以下是其中一些資料:

根據史丹福大學在2千年所做的一項調查，美國有4.8％的新生兒舌繫帶是過短的，且男生與女生比起來，男生是2.6％，女生是1％。

臨床上，有些學者醫師依據小朋友將舌頭往前伸的動作，評估出舌繫帶的輕重程度：

A. 輕微舌繫韌帶過短：指寶寶舌頭所能伸出來的長度在12～16mm。
B. 中等舌繫韌帶過短：指寶寶舌頭伸出的長度在8～11㎜。
C. 重度舌繫韌帶過短：指寶寶只能伸出3～7㎜。
D. 完全舌繫帶沾黏：寶寶舌頭所能向前伸的長度在3㎜以下。


寶寶需要剪舌繫帶嗎？

寶寶如果舌繫帶有問題到底需不需要動手術呢？林孝禺醫師說，家長在考慮手術前，最好先評估一下再做決定。

1.哺乳問題：媽媽因哺乳時困難，在Baby出生後，為了哺乳方便，可考慮進行評估。18世紀古羅馬時代的時候，有產婦會用他們的長指甲，直接將寶寶的舌繫帶切開，結果常導致出血或感染的後遺症，這樣的手術到現在一直被持續討論當中。

2.語言發展：擔心舌繫帶對寶寶說話造成影響？特別是在學中文和英文時所需要的捲舌音和齒間音，容易使孩子發音不準或說不出來。其實需要語言治療的小朋友，不一定就有舌繫帶的問題；因為牙齒的發育、舌頭本身的大小、舌頭的感覺及運動功能，都能補償舌頭較短限制，也可以說出標準的構音。一般認為可以到三歲時，語言確實有構音障礙時再說，沒有必要提早手術來預防語言問題的發生。

手術可以由簡單的外科組織切除、縫合，到利用電刀或是雷射的方式均可。但是手術的適切性都值得家長與小兒牙科，或口腔外科、小兒外科等專業醫師進行評估、討論後再決定。儘量減少孩子痛苦與恐懼的考慮下，做最安全與適合的手術建議，或是簡單的定期追蹤，不一定需要立刻做臨床處理。


A. 資料比較全面的website

http://www.peacehealth.org/kbase/topic/mini/hw183100/overview.htm

B. Detailed tongue tie pdf file by Dr. Brian Palmer, Tongue Tie Expert

http://www.brianpalmerdds.com/pdf/frenum_pdf.pdf

C. You tube tongue tie MD talk, case study and surgery (Billy - Moderate tongue tie boy)

http://www.youtube.com/watch?v=gueqVZ8sXNg

http://www.youtube.com/watch?v=odZBO5TPM8Q&feature=user

http://www.youtube.com/watch?v=mn_gq0D1oWE&feature=user

http://www.youtube.com/watch?v=-frXcgK5rHc&feature=user

http://www.youtube.com/watch?v=VrppmKQHrLk&feature=user

http://www.youtube.com/watch?v=2pvpz1DwE2Y&feature=user

http://www.youtube.com/watch?v=CGA6LLsvLGM&feature=user

http://www.youtube.com/watch?v=ejyDTbiYzkI&feature=user


D. Tongue Tie laser surgery - not much pain, not much blood

http://www.truveo.com/Tongue-Tied/id/3884717226

E. Tongue Tie Net - new view about tongue tie

http://www.tonguetie.net/index.php?option=com_content&task=view&id=3

Speech

Under-developed oral kinaesthesia is the result of individuals with a tongue tie having a very poor sense of the geography of the mouth, because they have such a limited range of lingual movements. Speech problems occur which are difficult to correct by conventional means because they cannot memorize the correct movements of speech, or be sure of always achieving them. Adults develop methods of speech which mask their difficulties with sounds.

Both adults and children often try to speak with a small oral aperture, so that they can make the lingual contacts required for pronouncing consonants; others speak slowly, softly or loudly. Nearly all patients past toddler stage are aware of the movements their tongue cannot make. Clarity in rapid speech is almost always impossible for a tongue-tied person to achieve.
The movements that tongue tie renders difficult may vary from patient to patient but some movements - such as lingual elevation to the upper teeth and horizontal lingual protrusion - are consistently difficult or impossible to achieve because of the pull of the tight lingual frenum on the floor of the mouth and on the tongue. Other movements (whether articulatory or unrelated to speech) can only be achieved under optimal conditions: during careful speech, after prolonged speech therapy, when concentrating, and when talking slowly.

Thus it is seen that many with tongue tie learn to compensate for their limited tongue mobility by adopting alterations of movements. These are rarely successful since they are often conspicuous or inefficient.

(文章草草, 有機會再整理...)






[ 本文章最後由 lycheema 於 08-8-8 13:29 編輯 ]

wyh:)

hi,

我都帶左阿囝(19m)去葉醫生度剪脷根
另外同佢做緊口肌訓練
真的在進步中
多謝版主的提醒啊！

conniewktang

我仔係剪咗才去做私家語言治療，所以進展唔錯，現在不用做了。

conniewktang

我個仔去年復活節後葉醫生剪利根，現三歲三個月，之前接受了八個月私家語言治療，現說話牙尖咀利，去年十一月又考到幾間冇學券的有名幼稚園。當時葉醫生話我仔可剪可不剪，我決定剪，剪完他好多音開始發倒，當然我又買明愛果套教材每日同佢做訓練，又加上佢上語言治療及做家居訓練，現在廣東話ok,我開始訓練佢英文同普道話了。好彩快手剪咗，沒有錯過語言治療的黃金期，多謝葉醫生。

粒粒芝士

我囝2歲半時都係葉醫生度剪左，真係好快手，之前成日發音有問題且唔係講好多野，多數單字（唔多明佢講乜），而家3歲4個月會講完整一句說話了！所以我都後悔唔早d剪

Colin_BB

不過痛都是只有該十秒, 之後囝囝都唔痛了. 連藥都唔駛食. 今早都可以正常食飯了.  為左囝囝的將來, 都應該係值得的. 如果唔係等到四歲才發理要做, 到時更慘, 而且很大機會要全麻

至於傷口同手勢, 我唔識又冇得比較. 但睇落佢應唔錯的.

最後, 再分享下. 囝囝去睇生前一星期, 我每天都同佢係度玩 剪脷根 遊戲. 囝囝習慣了才配合了醫生剪. 要帶小朋友去剪前, 記得先同小朋友多玩, 如果唔係小朋友唔配合係剪唔到的.  總之, 感謝主, 總算順利平安做好了.

Colin_BB

囝囝兩歲半, 醫生都話左2次會好痛. 醫生技術應該算熟練. 囝囝同我都未反應過來, 第一下.就剪了. 由於囝囝脷根硬, 總共剪了3次. 過程不用十秒.

但如果大家想幫BB做, 真係越早越好. 不然, 真的要有心理準備. 雖然過程唔駛10粆, 但囝囝叫得真係好慘, 我個心都碎了, 差O的都喊左出黎. 出黎見到等症的家長全部都好似好驚咁望住囝囝. 重好關心問我囝囝剛做了什麽手術.

Colin_BB

擒日終於睇左, Dr Yip 睇左後話可囝囝講野都算可以, 可剪可不剪. 最後我都決定即時剪了.



補充一下:(我仔仔本身好多野講,bb音較多, 唔係講唔到. 但條脷底係睇到有黐脷根, 條脷好免强先掂到嘴唇, 有好輕微的蝴蝶脷.)

Colin_BB

回復 man811231 的帖子

我是約了下星期六, 13號睇完再同大家分享

man811231

原帖由 Colin_BB 於 13-04-05 發表
囝囝約了一星期六 見Dr Yip了, 希望手術真的不會太痛啦...

God Bless.

我個三歳幾都很小說話，也約了葉醫生看看。你今天看完後，怎樣呢？

Colin_BB

囝囝約了下星期六 見Dr Yip了, 希望手術真的不會太痛啦...

God Bless.

Colin_BB

呢個post 真的很有用...衷心感謝.

在農曆年後, 我要帶仔仔 去見Dr Yip.

conniewktang

Thanks for sharing, I will take my son to see Dr Yip as soon as possible after the Easter holidays.

Issac_BB

hi, 我個仔都係輕磅, 言語發展遲緩, 現家4歲, 都係D "F"音, "LA"音唔得, 言語治療都係話口肌弱講嘢時條脷又唔旭,脷根緊, 我同佢TRAIN 左一年啦, 係有進步, 但都係比同齡小朋友"叉", 我YESTERDAY 都同佢剪左脷根, 希望有幫助, 大家都要努力!
'

原帖由 amon28 於 09-2-26 09:53 發表
你好,可否告知你小朋友的情況,醫生有冇解釋條脷活動正常,為何發音不準呀

我仔係早產導致發展遲緩,有好多音都講得唔準,言語治療師話口肌弱講嘢時條脷又唔旭,脷根緊但冇影響發音,隨着年齡增長,仔仔講嘢清晰咗,開始發 ...

teekayma

呢個post 非常有用！讚！



請問s 音同埋z 音發得唔好，又係咩野問題呢？

moyan

Dr.Ip 有冇做water laser?
water laser是否唔痛?

NT-1

原帖由 Rubyhoward 於 11-5-16 12:34 發表
NT-1
Thanks for your advice. My son finally did the operation on 6th May. Now is 10 days after operation, but my son is not willing to 伸舌头，or touching the left or right end of lips...I found he is s ...

Dear Rubyhoward,
Does  the operation involve the cutting and stitches under the tongue??  How is your son recovery progress??  Sometimes, recovery takes time with major incisions.  My daughter only had a simple incision under her tongue with the latest technology "water laser" which claims to produce the least trauma and pain to the patient but she still felt discomfort within several days after the surgery.  I suspect your son may need more time to heal.  In term of tongue movement, my daughter takes time to adjust.  In fact, my girl starts to know how to elevate the tip of her tongue to upper teeth 2 months after the surgery.  Your son is still very young and I would suggest you to give your son some rooms before you decide whether a speech therapist is   necessary.

Rubyhoward

NT-1
Thanks for your advice. My son finally did the operation on 6th May. Now is 10 days after operation, but my son is not willing to 伸舌头，or touching the left or right end of lips...I found he is still using the old way to talk...he is now 2 years and 3 months, I try to teach him to do some tongue exercise, but he did not follow and just walk away...not sure whether the tongue still painful? How can I help my son, should I find some speech theraphy for him?
Thanks
Rubyhoward

Mcdondon123

May I also have the contact of Dr. Yip?
My son is almost 3 yrs old now and we found him to have toungue tie. We've consult few Drs,all said he's doesn't need surgery, just go to ST. But teacher also mention the problem to us, so I want to do a consult with Dr Yip again who support snip. Thanks in advance.

flowerw88

很多謝lycheema 的文章分享和醫生的介紹，雖然是 08年的舊文，但今天幫了我仔仔！thx~

NT-1好多謝你的祝福！

Rubyhoward，我覺得Dr Yip信得過。因為他看完我仔仔後，話佢不嚴重，建議我地不做手術，3歲再睇，到時才決定。

Dr Yip以割包皮為比喻。每個男人都可以割，但唔割都得。

由於我有tongue tie，所以唔想擔心仔仔咁耐，堅持要做手術。最後，Dr Yip都幫我仔做，$3300。

手術過程和其他網友所話一樣。