Allergic Reactions to Tetracaine-Phenylephrine in Neonatal Lingual Frenotomy: Clinical Insights.

Abstract

BACKGROUND Infants born with a short lingual frenulum, a condition known as ankyloglossia or tongue-tie, can experience breastfeeding difficulties and often require surgical frenotomy to restore functional mobility. Topical anesthesia is commonly used to minimize discomfort during the procedure, and adverse reactions are rare. This case report describes a 48-day-old female infant who experienced an allergic reaction to topical anesthesia with tetracaine and phenylephrine during frenotomy. CASE REPORT A 48-day-old infant with ankyloglossia and breastfeeding difficulties was referred for specialized dental evaluation. Laser frenotomy was indicated and performed under topical anesthesia with tetracaine and phenylephrine, followed by infiltrative anesthesia with lidocaine. During the application of the topical anesthetic, the patient developed lip edema and vesicles, which led to a diagnosis of ophthalmic anesthetic-induced angioedema. The procedure was completed without further complications, and the patient showed progressive improvement of the allergic condition postoperatively. CONCLUSIONS This case report highlights a rare complication of topical anesthesia with tetracaine and phenylephrine during frenotomy in a 48-day-old infant with breastfeeding difficulties. The observed allergic reaction emphasizes the importance of caution when using medications outside their intended scope and underscores the need for careful monitoring of adverse effects during procedures.