Progesterone
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Superior ankyloglossia syndrome following in utero exposure: case report A 3-day-old male neonate developed superior ankyloglossia syndrome following in utero exposure to progesterone. The neonate presented with the tip of the tongue attached to the upper palate and abnormal external genitalia. He was born during 36 weeks of gestation by normal delivery. His 25-year-old mother (G3 P1) had a history of two spontaneous abortions; therefore, the mother had received progesterone tablets until seven months during this pregnancy. However, the mother experienced three episodes of per vaginal bleeding, throughout all the three trimesters. At the current presentation, the neonate had difficulty in sucking and the mother squeezed breast milk in his mouth. Later, it was noted that tip of his the tongue was attached to the front of the hard palate by a thick broad fibrous band. Therefore, a feeding tube was inserted from the right side, which was not seen from the left side. His genital examination revealed severe chordee without hypospadias was found, and the ventral penile skin was absent, also penoscrotal transposition, and the testes were descended. An ECG showed a small patent ductus arteriosus (PDA). The anaesthetic consultant agreed it difficult intubation and nasotracheal intubation was not available. The defect was unable to correct under local anaesthesia. Therefore, the attachment was released with bipolar diathermy on the seventh day of life under IV anaesthesia. Later, a small bridge of tissue on the anterior part of secondary cleft palate was noted. He also had a superior thick labial frenulum, also there was limited space between the tongue and the inferior alveolus/gingiva. After six hours of the procedure, he was starting feeding with a dropper. On the first day after surgery, his mother noted bleeding while feeding him. Therefore, feeding was stopped for one day. Subsequently, his bleeding stopped after application of pressure and tranexamic acid. The feeding was started on the second day of surgery with a pharyngeal spoon. Thereafter, no bleeding was observed. The neonate was discharged on day seven after surgery. His cleft palate, the posterior ankyloglossia, penile chordee, transposition and superior labial frenulum were planned to repair at age of 10 months. Chowdhury TK, et al. Superior ankyloglossia syndrome. Journal of Pediatric Surgery Case Reports 61: 101611, Oct 2020. Available from: URL: http://doi.org/10.1016/ 803503496 j.epsc.2020.101611
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Reactions 26 Sep 2020 No. 1823
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