Necrosis of the Tip of the Tongue After Frenular Surgery

Routine examination of a 4-year-old girl—who had no speech defects or eating problems—revealed apparent shortening of the frenulum. She could not touch her gums with her tongue. With the patient under general anesthesia plus local anesthesia using articaine with added epinephrine 1:100 000, we performed frenectomy and lengthening Z-plasty of the tongue. No complications were evident immediately after operation, but on the next day the tongue was swollen, extruding permanently from the mouth. The swelling resolved after rectal administration of prednisone 100 mg. Some days later proglossal necrosis became apparent. The photograph shows detachment of the tip of the tongue 9 days after surgery. The patient temporarily lost weight because she no longer wanted to eat properly. Her speech was initially muffled but was soon restored to normal. This extremely rare complication may be explained by hard postoperative biting of the bothersome anesthetized tongue or by an iatrogenic infarction caused by the operation. Intravasal injection of epinephrine is a less likely cause, because in that case tachycardia would have become evident, for instance.

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Dr. med. Kay Brantsch, Zollernalb-Klinikum Balingen und Albstadt, Zentrum für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, [e-mail]

Dr. med. dent. Moritz Kager, Kieferwerk Tübingen, Praxisklinik für Implantologie und Oralchirurgie

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Brantsch K, Kager M: Necrosis of the tip of the tongue after frenular surgery.
Dtsch Arztebl Int 2023; 120: 746. DOI: 10.3238/arztebl.m2023.0116