Patient H.V.P.D., 16 years old, presented with a chief complaint of impaired mobility.
During the physical examination, the patient presented a high facial pattern III, with severe maxillary hypoplasia, dental crowding, class III defida relation, anterior open bite, anterior open bite, vulture,
Data collection during anamnesis also revealed that, at birth, the patient had a defect in the abdominal wall that was subsequently corrected.
All these findings contributed to the formation of the diagnosis of Beckwith-Wiedmann syndrome.
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The patient was incorporated into the oro-surgical treatment and problems related to constipation and respiratory difficulties were observed, with a strong correlation with macroglossia.
Therefore, a surgical procedure of partial glossectomy prior to the orthognathic surgery procedure was planned for this case.
The technique used was proposed by Obwegeser et al. (1964)10, in which a resection of the central segment and the apex of the tongue was performed, in which the anteroposterior dimension was related to the reduction of its problems.
For adequate control of transoperative bleeding and performance, surgery was performed under general anesthesia with orotracheal intubation due to the presence of nasal turbinate hyperkeratosis that prevented passage of the probe.
To perform the incisions, cotton 2.0 thread stitches were established in the lateral and anterior extremities of the tongue and a repair clip was used to assist in Allis type dissection.
After stabilization, the incision was made with blue dye methylene and local anesthetic procedures ( lidocaine 2% with epinephrine 1:200,000).
The removal of the segmented nerve was performed with electrical surgical diversion (needle dissection, Stryker Corporation®) in the apex-base direction of the lingual lesions, minimizing the risk of lingual lesions.
The segment was removed and careful hemostasis was performed to minimize the risks of lingual hematoma and postoperative bleeding.
After bleeding control, the segments were approximated with a resorbable thread (Vicryl 3.0-ETHICON) from the deepest to the superficial portion in a meticulous base-apex direction.
In the immediate postoperative period, it was possible to verify the anterior and transverse decrease of the tongue without airway compromise, without any complication of hemorrhagic or infectious nature.
Ten days after surgery, the patient began speech therapy to help the return of tongue motility and consolidation.
Currently, the patient is 3 years postoperatively and there is a considerable decrease in the size of the tongue in the transversal and longitudinal direction, without reports of loss of taste or taste in the region.
It is following a speech therapy and orthodontic treatment with the purpose of performing a surgical procedure for the correction of maxillomandibular discrepancy.
