Life-threatening non-angioneurotic swelling of the tongue as a complication of frenotomy in an eight-year-old boy

Abstract

Introduction: Frenotomy is considered a safe procedure. The rare complications include bleeding, scarring and occasionally others such as those related to airway obstruction and hypovolemic shock. Case report: An 8-year-old boy with a history of tongue oedema and allergy underwent frenotomy under local anaesthesia. The patient was discharged home without any complications. The following day, a massive swelling of the tongue appeared, requiring hospitalisation. Revision surgery was immediately performed and haematoma was ruled out as a cause of the oedema. COVID-19 infection was detected. As the patient’s general condition had deteriorated, he was intubated and fed through a nasogastric tube. A subsequent pharmacological treatment using intravenous steroids and antihistamines was administered, causing the tongue swelling to gradually subside. The patient was extubated on the 4th day following his admission to hospital. Quincke’s oedema, allergic reaction to an inhalant or food allergens, and the local anaesthetics were excluded as possible causes of the oedema. The cause was not determined, though a hypothesis was put forward that it was related to the COVID-19 infection. The patient was discharged from hospital after 14 days in good general condition. Conclusion: A history of tongue swelling increases the risk of complications after frenotomy and requires an extended observation period