This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Large Tongue
By Pam Marshalla
Q: I evaluated a 4;6 male with a 4mm open bite. He used a sippy-cup and pacifier. I advised to eliminate the sippy cup and pacifier, but what was noticeable on oral exam was that he had a really long tongue. Is it possible the tongue is just too large for his oral space? Is there a quantitative way to measure this?
I find this to be one of those impossible-to-answer questions. We have no way of knowing clinically if the tongue is too big, and it is usually ridiculous to refer a client like this for the kind of medical evaluation that would give us the answer. The referral would be to the nearest cleft palate team that can do a cephlometric study.
It is important to note that the tongue is always too large for the oral space in infancy, but that the mouth should be able to accommodate it easily by this age.
An orthodontist might be able to advise.
I would be tempted to see him every 3-6 months just to watch the situation to see if it resolves or not.
Couldn’t it just be low tone?
Yep- Should have mentioned that. Low tone always makes a tongue look too big.
I always look at the tongue size in relationship to the hard palate height and width as well as tonsil size to get a feel for why the child’s tongue is testing where it is. For example, is this child’s tongue resting forward in his oral cavity with the mandible below neutral? And if so, is it because he has enlarged tonsils or a palate that is too narrow to contain the width of his tongue?