Compensatory “rolling-like” tongue motion after circumferential tongue necrosis without reconstruction: A functional adaptation phenomenon

Background: Severe self-inflicted tongue injury may result in extensive tissue loss and functional impairment. Although acute management strategies have been described, long-term functional adaptation following circumferential necrosis treated without reconstruction remains insufficiently characterized. Case presentation: A 67-year-old woman with major depressive disorder developed circumferential tongue necrosis after repeated self-inflicted biting. Emergency management consisted of debridement and primary closure. Reconstructive surgery was deferred because of psychiatric instability and systemic risk. At 1-year follow-up, epithelial healing was complete, but tongue protrusion and segmental deformation were markedly restricted. Instead of linear protrusion or localized tip shaping, en bloc rotational displacement of the residual tongue was observed. This compensatory rotational displacement may reflect altered traction vector dynamics of preserved extrinsic muscles under circumferential intrinsic scar contracture. Discussion: Circumferential scar contracture appeared to restrict intrinsic muscle-mediated three-dimensional deformation while permitting limited extrinsic muscle-driven displacement. Altered traction vector dynamics may explain the characteristic rotational movement pattern. Despite persistent fine motor impairment, basic speech intelligibility and oral intake were preserved through compensatory mechanisms. Conclusion: Conservative management of circumferential tongue necrosis may allow partial long-term functional adaptation under selected conditions. Recognition of characteristic compensatory movement patterns may assist in reconstructive decision-making.