The dysglossia is a disorder of the articulation of the phonemes due to malformations or anatomical and / or physiological alterations of the peripheral articulatory organs.
All this hinders the linguistic functioning of people without detectable neurological or sensorial affectations.
Etiology of dysglossia
The causes that can cause dysglossia are congenital craniofacial malformations, growth disorders, peripheral paralysis and / or anomalies acquired as a result of lesions in the orofacial structure or of excisions.
There are three aspects that can be related to dysglossia. However, we must bear in mind that these aspects do not constitute a direct cause of the dysglossias, although they do worsen the picture, since it is difficult for the affected person to set in motion the compensatory mechanisms to improve spontaneous speech.
These aspects are:
a) Intellectual deficiency in variable degree : very close to syndromes that affect the craniofacial structure.
b) The psychosocial deprivation derived from the physical appearance and the physiological difficulties that are derived from the anatomical alterations.
c) Hearing loss as a result of inadequate structure or alterations of the hearing organs of a specific syndrome.
These aspects interfere in the course of treatment, preventing the individual from improving as expected.
Among the symptoms of dysglossia, we can distinguish, on the one hand, the nuclear symptomatology, and on the other hand, the associated symptomatology.
a) Nuclear symptoms
The central symptomatology is characterized by an alteration in the articulation of different phonemes due to anatomical malformations of the peripheral organs of speech and of non-neurological central origin.
b) Associated symptomatology
Symptoms associated with dysglossia are the presence of rhinophonies, which are voice alterations derived from lesions in the resonance cavities.
In addition, we find psychological disorders consistent with the speech problem, such as, for example, that the person with this disorder rejects talking.
In addition, this disorder can occur associated with school delay, difficulties in literacy, difficulties in normal speech fluency, hearing loss (especially in cleft palate) and other difficulties that are related to long stays in hospitals.
On the other hand, we also find the lack of stimulation appropriate to their level of development and the erroneous belief that dysglossia is inevitably linked with intellectual retardation.
Classification of the disglosias and main characteristics
1- Lip dysglossias
Lip dysglossias are a disorder of the articulation of phonemes due to the alteration of the shape, mobility, strength or consistency of the lips.
Those that occur more frequently are due to:
a) Cleft lip : it is a congenital anomaly that goes from the simple depression of the lip to its total cleft.
The malformation can be unilateral and bilateral depending on the affected side. So the cleft lip can be unilateral or bilateral and simple or total.
The most severe form of this malformation is called a middle or central cleft lip.
b) Hypertrophic upper lip frenulum : the membrane between the upper lip and the incisors develops excessively. They have difficulties in articulating the phonemes / p, / b /, / m /, / u /.
c) Fissure of the lower lip : cleft in the lower lip.
d) Facial paralysis : often consequence of the forceps producing lesions and anomalies in the middle ear. They have difficulty pronouncing the phonemes / f /, / n /, / or /, / u /.
e) Macrostomia : lengthening of the buccal cleft that may be associated with malformations in the ear.
f) Wounds labial : some wounds in the area of the lip that could cause alterations in the articulation of the phonemes.
g) Trigeminal neuralgia : abrupt, short-term pain that appears on the face in the ophthalmic, upper and lower jaw areas.
2- Mandibular dysglossias
Mandibular dysglossias refer to the alteration of the articulation of the phonemes produced by an alteration of the shape of one or both jaws.
The most frequent causes are:
a) Maxillary resection : the upper jaw separates from the lower jaw.
b) Mandibular atresia : anomaly caused by an arrest of the development of the lower jaw of congenital origin (endocrine disorders, rickets, etc.) or acquired (use of a pacifier, sucking your finger, etc.), which ends up producing a bad occlusion of the jaws.
c) Maxillofacial dysostosis : it is a rare hereditary disease that is characterized mandibular malformation derived from other anomalies and that gives rise to the typical appearance of “fish face”.
d) Progeny : growth of the lower jaw that produces malocclusion of the jaws.
3- Dental disgloses
Alteration of the shape and position of the teeth due to inheritance, hormonal imbalances, feeding, orthodontics or prosthesis.
4- Lingual dysglossias
It is characterized by the alteration of the articulation of phonemes by an organic disorder of the tongue that affects the speed, accuracy and synchronization of the movements of the tongue.
The most frequent causes are:
a) Ankyloglossia or short frenulum : the membrane under the tongue is shorter than normal.
b) Glossectomy : total or partial extirpation of the tongue.
c) Macroglossia : excessive size of the tongue that produces respiratory problems (characteristic in Down syndrome ).
d) Congenital malformations of the tongue : arrest in embryological development.
e) Microglossia : minimum size of the tongue.
f) Paralysis of the hypoglossal : when the tongue can not move and there are problems to speak and chew. It can be bilateral or unilateral.
5- Palatal dyslexia
It is an alteration in the articulation of phonemes caused by organic alterations of the bony palate and the soft palate.
The pathologies in which the normal structure is affected are called:
a) Palatal cleft: congenital malformation of the two halves of the palate seriously hindering swallowing and speech.
The cleft lips or palatinas originate in the first weeks of gestation.
b) Submucosal fissure : malformation where the palate is cleft.
To begin with the evaluation of the dysglossias, it is appropriate to make an anamnesis to be able to know:
- The reason for the evaluation.
- Family background.
- Pregnancy and childbirth
- Psychomotor development
- The development of speech.
- The development of the dentition.
- Breathing (diurnal and nocturnal -presence or not of snoring-).
- Adenoid problems, in the tonsils, rhinitis and otitis.
- Use of pacifier, drooling, lip, digital, cheek, tongue, objects, bite of objects, etc.
- Hospitalizations, surgical interventions and relevant diseases.
Subsequently, we will proceed to the comprehensive assessment of the bucco-organs:
Observe the lips at rest: we must indicate if they are closed, half open or wide open.
- Also, we must pay attention to the shape of the same to know if they are symmetrical or asymmetrical, the shape of the upper and lower lip indicating if it is short, normal or long, and the presence of scars, as well as their location and characteristics.
- The labial mobility is evaluated by asking the child to move the lips to the sides, project them, stretch them, make them vibrate and wrinkle them as if to kiss. We will record if the lips move normally, with difficulty or there is no movement.
- Tonicity: we will observe the labial tone through the exercise of the kiss and we will touch with the finger the upper and lower lip to notice the resistance of the same and we will label it as normotonia, hypertonia or hypotonia.
- Lip frenulum : through observation we will evaluate if the lower or upper labial frenum is short and if the superior is hypertrophic.
- Observe the tongue at rest and see if it is placed on the hard palate, interposed between the dental arches, laterally pressing the arches or projected on the upper or lower arch.
- Form : we ask the child to stick out his tongue and we attend to the form that the language presents, it can be normal, microglossia / macroglossia, wide / narrow and voluminous. It is important that we check if there are lateral marks of the teeth.
- Mobility : the child is asked to move the tongue to the sides, raise it, project it, make it vibrate, etc. So we will evaluate if it moves normally, with difficulty or there is no movement.
- Tonicity : to detect the tone of the tongue we use a tongue depressor and push the tip of the tongue while the child resists. Through this exploration we can detect if the language is normotonic, hypertonic or hypotonic.
- Lingual frenulum : we ask the child to raise their tongue to verify its form. If it is difficult, we ask you to suck the tongue against the hard palate and keep it. This allows us to observe if the lingual frenum is normal, short or with little elasticity.
- Form : when observing the palate we must look at the form it presents, it can be normal, tall, ogival, wide or narrow, flat, short, with scars.
- Palatal folds : observe if the folds of the hard palate are normal or hypertrophic.
- We observe the soft palate at the end of the oral cavity . One of the elements that we must attend to is the uvula. When observing it, we must indicate if it presents a forked structure or if it is long, short or non-existent.
- We must detect the presence of scars or fistulas on the white palate.
- We will observe its dimension , indicating whether it presents a conventional dimension or is shorter than what would be expected.
- Mobility : to be able to observe the mobility of this area of the bucofonador device we must ask the individual to emit the phoneme / a / during the exploration. So we can see if mobility is good or is diminished or absent.
- Dental / maxillary arches : or bservar if the dentition is temporary, mixed or permanent.
- Take care of the absence of dental pieces .
- See if there is separation in the teeth , where and in what way you can influence the language.
- Malformation of dental pieces .
- Indicate if you have dental prosthesis , fixed or removable.
- State of the gums : normal, inflamed or bleeding.
- How is the bite of the person .
- Ability to open the mouth : difficult, does not open, disengages the jaw, etc.
- Observe whether there is frontal symmetry between the right and left sides of the face.
- Facial profile : normal, retrusion or forward projection of the jaw.
Another relevant aspect for dysglossia is the evaluation of orofacial functions. For this, we must attend:
Observe if breathing occurs nasally, buccally or mixed, if there is respiratory coordination. In addition, it is also important to evaluate the breath control and measure lung capacity.
To evaluate the way swallowing, the individual is offered water or yogurt and we observe the placement of the lips, the tongue and the pressure that is exerted to swallow the food.
In order to evaluate the chewing, the subject is offered a type of donut or cookies and the movements that are made with the mouth and with the tongue are evaluated.
It is important to attend to the tone of voice, to the existence or not of hypernasality and to the existence of articulatory difficulties.
As we have commented previously, people with dysglossia may have hearing problems, so it is also important to evaluate the ability of hearing discrimination.
For this, we will attend to:
Auditory discrimination of sounds
Sounds of everyday objects are presented and asked to identify them. For example, sounds of coins or a crumpling paper.
Auditory word discrimination
Words with similar phonemes are presented and the person has to identify the difference.
In the treatment of dysglossia, it is important that a multidisciplinary intervention be performed given the nature and character of this language disorder.
Because disgloisa is a disorder that affects different areas of the individual, through the coordination of a team of professionals we can achieve that the patient can achieve a normative development.
The professionals that would integrate this multidisciplinary team would be:
- Neonatologist : is the first professional with whom the child enters the contact and with whom the treatment is initiated.
This professional performs rapid assessments of neonatal growth and development, is that he performs an assessment of the anomaly or malformation detected and thus can determine the best way of feeding and mobilize available resources for the child to be operated by the team.
- Pediatrician : is the one who will follow up, is the professional who has direct contact with parents and has the mission to inform and accompany during treatment.
In addition, you must be in communication with the other members of the multidisciplinary team.
- Orthodontist : is the professional who is responsible for correcting initially and during the evolution of the treatment a correct dentition, accommodation of the palate and teeth.
- Speech therapist : specialist who will treat the functional part of the initial part of the digestive and respiratory system. The objective is for the individual to achieve a correct phonation function.
- Psychologist : this professional will work with the parents and with the child.
On the one hand, first the work will be directed towards the parents to try to alleviate the pain they feel at the malformation and treatment of their child.
On the other hand, the psychologist will work directly with the child so that he / she can achieve a normalized social integration and have an adequate self-esteem.
- Surgeon : coordinates the treatment explaining, supporting and sending the child to consult and integrate the treatment until the surgical correction is made. It is convenient to start the surgical treatment during childhood so that the oral organs that are altered can be repaired before the speech starts.
It is likely that operations are repeated when the patient is an adult.\
- Other professionals : social workers, aesthetic surgeons, otolaryngologists, anesthetists, etc.