Patient H.V.P.D., 16 years old, presented with the main complaint of difficulty in phonation. During the physical examination, it was observed that the patient presented with tall stature, facial pattern III, with severe maxillary hypoplasia, dental crowding, Angle class III relationship, anterior open bite, bifid uvula and macroglossia. On collecting data during the anamnesis, it was also revealed that, at birth, the patient had an abdominal wall defect which was subsequently corrected. All these findings contributed to the formation of the diagnosis of Beckwith-Wiedmann syndrome.

The patient was incorporated to orthosurgical treatment, being observed swallowing problems, phonation and breathing difficulties, with strong correlation with macroglossia. Therefore, a partial glossectomy surgical procedure was planned for this case, prior to the orthognathic surgery procedure. The technique used was that proposed by Obwegeser et al. (1964)10 , in which the central segment and the apex of the tongue were resected, thereby reducing its dimensions in the anteroposterior and transverse directions, so that the problems related to speech were attenuated.
For adequate control of transoperative bleeding and ease of execution, the surgery was performed under general anaesthesia with orotracheal intubation, due to the presence of hypertrophy of the nasal turbinates that prevented the passage of the nasotracheal tube. To make the incisions, repair points were established with 2.0 cotton thread at the lateral and anterior extremities of the tongue and an Allis type tissue grasping forceps were used to assist in the dissection. After stabilisation, demarcation of the incision with methylene blue and infiltrations of local anaesthetic (lidocaine 2% with epinephrine 1:200,000) were performed. Removal of the demarcated segment was performed with an electric surgical dissector (colrado needle, Stryker Corporation®) in the apex-base direction, preserving the lateral edges and minimising the risk of injury to the branches of the lingual nerve. The segment was removed and careful haemostasis was performed to minimise the risks of lingual haematoma and postoperative bleeding. After bleeding control, the segments were approximated with resorbable thread (Vicryl 3.0-ETHICON) from the deepest to the superficial portion in a thorough base-to-apex approach. In the immediate postoperative period it was already possible to verify the anterior and transverse reduction of the tongue without compromising the airway, and without any complications of a haemorrhagic or infectious nature. Ten days postoperatively, the patient started speech therapy to help the return of tongue motility and phonation.
Currently, the patient is 3 years postoperative and has a considerable decrease in the size of the tongue in the transverse and longitudinal direction, with no reports of sensory or gustatory loss in the region. He is undergoing phonoaudiological and orthodontic treatment with the aim of carrying out a surgical procedure to correct the maxillomandibular discrepancy.

