Salvage Frenuloplasty With Porcine Small Intestinal Submucosa Graft in a Newborn Following Unsuccessful Laser Release: A Case Report.

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.