Following the previous diagnosis, what treatment does this patient require?

Correct answer: D. Frenectomy (or frenotomy) of the lingual frenum

• A. Arch expansion addresses transverse skeletal or dental discrepancy. It has no bearing on a restrictive lingual frenum.
• B. Significant ankyloglossia does not reliably resolve with growth. Mild cases may become less limiting, but a frenum causing documented functional impairment warrants treatment.
• C. Speech therapy alone cannot succeed when the anatomical restriction physically prevents the tongue from reaching the position a sound requires. The mechanical limitation must be released first.
• D. CORRECT. When ankyloglossia is producing a functional problem — here, a demonstrable speech impairment — surgical release is indicated. A frenotomy simply incises the frenum, while a frenectomy excises it; either can be performed with a scalpel, electrosurgery or laser. It is important to understand that surgery restores the RANGE OF MOTION but does not by itself correct speech patterns that have already been learned, so post-operative speech therapy and tongue mobility exercises are an essential part of the treatment rather than an optional extra.

Note: Indications for release: feeding difficulty in infants (poor latch, maternal nipple pain), speech impairment demonstrated by assessment, inability to clear food from the vestibule or to reach the palate, and mandibular anterior gingival recession from frenal pull. Cosmetic appearance alone is not an indication. Anatomical caution: the submandibular and sublingual ducts and the lingual nerve lie close to the surgical field.