Case ReportsMacroglossia following palatoplasty causing upper airway obstruction: Case report*,**,*,**
Section snippets
Report of case
A 2.5-year-old, male child weighing 15 kg presented for elective cleft palate repair. He had been delivered vaginally at term following an uncomplicated pregnancy. His birth weight was 2.9 kg, and he had left-sided complete cleft lip and palate. His lip and anterior palate had been repaired at the age of 1 year. There had been no anesthetic or surgical complication at that time.
Preoperatively, his general physical and systemic examination were essentially normal. The routine laboratory
Discussion
Postoperative, massive, lingual swelling is an unusual complication that can lead to life-threatening airway obstruction.5 Macroglossia may also occur from rapid expansion of silent tongue cysts or asymptomatic lymphangiomas caused by injury or infection.6, 7 It can also be seen after difficult and traumatic oral intubation, dental procedures, and prolonged neurosurgical operations done in the sitting position.8, 9, 10, 11, 12 Hypersensitivity reaction to various agents used for sterilizing
References (16)
- et al.
Predisposition to and late onset of upper airway obstruction following angiotensin-converting enzyme inhibitor therapy
Chest
(1992) - et al.
The take-back patient in ear, nose and throat surgery
Anesthesiol Clin North Am
(1993) Craniofacial malformations—clinical and genetic considerations
Pediatr Clin North Am
(1978)- et al.
Massive lingual swelling following palatoplasty
Anaesthesia
(1995) Anesthesia for cleft lip and cleft palate
Anesthesiology Rev
(1979)- et al.
A comparison of three technics of palatorrhaphy: In-hospital morbidity
Cleft Palate J
(1979) - et al.
Macroglossia causing airway obstruction following cleft palate repair
Anesthesiology
(1989) - et al.
Massive macroglossia and airway obstruction after cleft palate repair
Anesth Analg
(1988)
Cited by (11)
Postoperative massive tongue edema in craniosynostotic children
2011, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :The patient was placed in a left lateral position which was sufficient to relieve the airway obstruction. The tongue became normal size by the fourth postoperative day [3]. A recent case report in 2009 by Aziz and Ziccardi surmised that use of the Dingman mouth gag (a retractor used to move the tongue inferiorly allowing adequate visualization of the palate) contributed to lingual compression thereby increasing the likelihood of glossal edema [4].
Late onset tongue edema after palatoplasty
2011, Acta Anaesthesiologica TaiwanicaCitation Excerpt :However, in our patient, tongue edema occurred over more than 4 hours after surgery. Trauma during difficult intubation, emphysema caused by dental abrasion instruments, suppression of circulation by mouth gags, and impairment of the blood or lymph flow in the supine position with the head hanging are considered possible causes of edema of the tongue and oral floor after palatoplasty.3–5 In the present case, intubation was performed easily and smoothly, and there was no sign of emphysema on postoperative radiography.
Severe Glossal Edema After Primary Palatoplasty
2009, Journal of Oral and Maxillofacial SurgeryTONGUE EDEMA AFTER PALATOPLASTY: A CASE REPORT
2020, Encyclopedia of Surgery: Volume 1: (22 Volume Set)TONGUE EDEMA AFTER PALATOPLASTY: A CASE REPORT
2019, Case Reports in SurgeryAppropriate tongue blade length of the Dingman Mouth Gag for Japanese pediatric patients with cleft palate and mandibular micrognathia
2016, Cleft Palate-Craniofacial Journal
- *
†Professor and Head, Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma, PGIMS, Rohtak (Haryana), India.
- **
‡Reader and Head, Department of Plastic Surgery, Pt. B.D. Sharma, PGIMS, Rohtak (Haryana), India.
- *
§Senior Resident, Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma, PGIMS, Rohtak (Haryana), India.
- **
Address correspondence and reprint requests to Dr Gupta: 7/9J, Medical Enclave, Pt. B.D. Sharma PGIMS, Rohtak-124001, India, e-mail: [email protected]