Ref Number = PITIKA-ASPR0214
Johanes Ari Cahyo Prabowo, Ni Putu Siadi Purniti, Ida Bagus Subanada, Agus Rudi Asthuta, I Ketut Suanda
Ankyloglossia is a congenital oral anomaly, as the residual of embryologic tissue that localized between tongue and base of oral cavity. We report a rare case of infant with a grade IV of ankyloglossia and there is a mass that localized at oral base. The objective is to describe the proper assessment and management of posterior ankyloglossia with complication of oral cavity mass.

Patient was hospitalized at Sanglah Hospital under supervision of paediatric pulmonologist, paediatric nutritionist, and otorhinolaryngologist, due to severe pneumonia with frequent episodes of choking after feeding, and failure to thrive. Patient had difficulty for feeding, despite using special bottle feeder. 
On physical examination, patient had dyspnea with presence of rales on both lung fields. For the oral cavity examination, frenulum localized in the posterior edge of tongue after retracted posteriorly. Based on hazelbaker’s assessment tool for lingual frenulum function score (ATLFF) of less than  8, revealed to posterior ankyloglossia grade IV and surgical repair should be done for this patient. Glossoplasty and surgical mass excision was done to this patient. Biopsy result showed epithelioid hemangioma. On the follow-up, during two weeks after post-surgical intervention, patient had occult bleeding from operation site and worsening symptoms of respiratory function, thus, passed away due to severe pneumonia and respiratory failure.
This report presents a case of infant with posterior ankyloglossia grade IV with oral cavity mass of epithelioid hemangioma. Early recognizing and management by doing surgical repair of posterior ankyloglossia and mass excision is very important for prevention the complication of aspiration pneumonia, breastfeeding problem, and inadequate weight gain. 
Keywords: ankyloglossia, congenital, oral, epithelioid hemangioma, bleeding
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