Acute Amoxicillin - Clavulanate Hypersensitivity During Perioperative Management of Ankyloglossia: A Case Report

Author

Mr. A. Prathap, Grace S, Janani B. S, Jayashree T

Abstract

 Background

Ankyloglossia, commonly known as tongue-tie, is a condition characterized by restricted tongue mobility resulting from an abnormal or restrictive lingual frenulum. Although it is frequently recognized during infancy, symptomatic ankyloglossia may persist into adolescence and become clinically relevant when associated with functional limitations such as speech articulation difficulties. The decision to perform surgical release should consider the relationship between anatomical restriction and functional impairment.

Case Presentation

A 13-year-old male presented with longstanding speech articulation difficulty that had been present since childhood. Clinical assessment was consistent with ankyloglossia, and surgical tongue-tie release was planned. Preoperative evaluation demonstrated stable vital signs and satisfactory systemic status. Hematological, biochemical, coagulation, infectious disease, and cardiac investigations were performed. During hospitalization, an amoxicillin-clavulanate test dose resulted in an acute allergic reaction, following which the drug was discontinued and emergency treatment was initiated. After stabilization, the patient underwent tongue-tie release under anesthesia. The procedure was completed in approximately 15 minutes. Postoperatively, the patient was initially maintained nil per oral and subsequently advanced to liquid and semi-solid foods. Intravenous ceftriaxone, pantoprazole, dexamethasone, diclofenac-based analgesia, and ondansetron were administered. The postoperative course remained clinically stable without significant bleeding or wound-related complications. The patient was discharged in stable condition with oral medications and postoperative care instructions.

Conclusion

This case demonstrates the presentation and perioperative management of symptomatic ankyloglossia in an adolescent patient with longstanding speech articulation difficulty. Surgical tongue-tie release was successfully performed with an uncomplicated immediate postoperative course. The acute hypersensitivity reaction to amoxicillin-clavulanate emphasizes the importance of vigilant medication monitoring and prompt emergency management during perioperative care. Objective long-term assessment of tongue mobility and speech function remains important for evaluating functional outcomes following surgical release.

Keywords

Ankyloglossia; tongue-tie; lingual frenulum; tongue-tie release; speech articulation; adolescent; surgical management; case report

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References

1. Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, et al. Clinical consensus statement: ankyloglossia in children. Otolaryngol Head Neck Surg. 2020;162(5):597-611.
2. Fioravanti M, et al. Treatment of ankyloglossia: a review. Children (Basel). 2023;10(11):1808.
3. Visconti A, Hayes E, Ealy K, Scarborough DR. A systematic review: the effects of frenotomy on breastfeeding and speech in children with ankyloglossia. Int J Speech Lang Pathol. 2021;23(4):349-358.
4. Wang J, Yang X, Hao S, Wang Y. The effect of ankyloglossia and tongue-tie division on speech articulation: a systematic review. Int J Paediatr Dent. 2022;32(2):144-156.
5. Khan U, MacPherson M, Mellor J, et al. Comparison of frenotomy techniques for the treatment of ankyloglossia in children: a systematic review. Otolaryngol Head Neck Surg. 2020;163(3):428-443.
6. Carnino JM, Rodriguez Lara F, Chan WP, Kennedy DG, Levi JR. Speech outcomes of frenectomy for tongue-tie release: a systematic review and meta-analysis. Ann Otol Rhinol Laryngol. 2024;133(6):566-574.
7. Mills N, Pransky SM, Geddes DT, Mirjalili SA. What is the anatomy of the in-situ lingual frenulum? Clin Anat. 2019;32(6):749-761.
8. Walsh J, Tunkel D. Diagnosis and treatment of ankyloglossia in newborns and infants: a review. JAMA Otolaryngol Head Neck Surg. 2017;143(10):1032-1039.