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Salvage Frenuloplasty With Porcine Small Intestinal Submucosa Graft in a Newborn Following Unsuccessful Laser
Carlos O'Connor-Reina1,2, Maria Teresa Garcia Iriarte3, Laura Rodriguez Alcala1,2
1Otorhinolaryngology Department, Hospital Quironsalud Marbella, Marbella, 29680, Spain.
Insights
Severe scarring after infant frenotomy can impair tongue mobility. A porcine small intestinal submucosa (SIS) graft successfully reconstructed the tongue in a case of severe post-frenotomy scarring, restoring function and improving infant feeding.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Regenerative Medicine
Background:
- Frenotomy procedures are increasing globally.
- Post-frenotomy scarring can lead to significant complications, including restricted tongue mobility in infants.
- Management of severe scarring often requires surgical intervention.
Purpose of the Study:
- To present a case of severe ankyloglossia secondary to post-frenotomy scarring in an infant.
- To evaluate the efficacy of porcine small intestinal submucosa (SIS) grafting for reconstruction in such cases.
- To highlight potential surgical alternatives for managing neonatal oral mucosal fibrosis.
Main Methods:
- A 3-month-old infant with feeding difficulties post-laser frenotomy underwent revision surgery.
- Surgical intervention involved excision of fibrotic tissue and reconstruction using a porcine SIS graft.
- The patient's tongue mobility, feeding, and weight gain were assessed post-operatively.
Main Results:
- The infant showed restored tongue mobility and normal breastfeeding after the SIS graft procedure.
- Bristol Tongue Assessment Tool (BTAT) score improved from 0 to 6.
- Sustained functional improvement, normal feeding, and appropriate weight gain were observed at 12-month follow-up without recurrence.
Conclusions:
- Porcine SIS grafting is a viable option for infants with severe post-frenotomy scarring when primary closure is not feasible.
- This surgical reconstruction strategy may reduce the risk of recurrent scarring.
- Further studies are needed to establish the safety and reproducibility of SIS grafting in this context.
Introduction:
As the number of frenotomy procedures increases worldwide, the recognition and management of potential complications has become increasingly relevant. Postprocedural scarring following laser release may severely restrict tongue mobility in infants and occasionally requires surgical revision.
Case Presentation:
We report the case of a 3-month-old infant referred for persistent feeding difficulties and poor weight gain (5th percentile) after an unsuccessful laser frenotomy performed elsewhere. Clinical examination revealed severe ankyloglossia secondary to a dense restrictive scar, with a Bristol Tongue Assessment Tool (BTAT) score of 0. Revision surgery was performed under general anesthesia, consisting of complete excision of fibrotic tissue and reconstruction of the ventral tongue using a porcine small intestinal submucosa (SIS) graft to cover the mucosal defect. Intralesional corticosteroid therapy was not considered due to the absence of regulatory approval and limited safety data for intralesional use in infants with oral mucosal fibrosis. At 6-week follow-up, the infant demonstrated restored tongue mobility, normal breastfeeding, improvement of BTAT score to 6, and weight gain to the 50th percentile. At 12-month follow-up, the patient demonstrated sustained functional improvement, normal oral feeding without restriction, appropriate weight gain for age, and no recurrence of fibrotic scarring or tongue mobility limitation.
Discussion:
In this case, the extent of fibrosis precluded tension-free primary closure. The use of a porcine SIS graft facilitated mucosal coverage and aimed to reduce the risk of recurrent scarring. Given the limited pharmacological options available for neonatal fibrosis management, selected surgical reconstruction strategies may represent a reasonable alternative in severe cases.
Conclusion:
Porcine SIS grafting may be considered in selected infants presenting with severe postfrenotomy scarring when conventional closure is not feasible. Longer follow-up and additional cases are needed to establish safety and reproducibility.
