Massive benign lingual tonsil hyperplasia and tracheostomy

Abstract

ApstraktOpisujemo slučaj prekomerne hipersplazije lingvalne tonzila kod odraslih uprkos prethodnoj tonzilektektomiji koja je zahtevala inicijalnu traheostomiju da bi se kompletno uklonilo limfoidno tkivo. Raspravljamo o poteškoćama u intubaciji u proceni disajnih puteva. AbstractWe describe a case of excessive lingual tonsil hyperplasia in adult despite previous tonsillectomy which required initial tracheostomy to complete removal of lymphoid tissue. We discuss intubation difficulties in evaluation of airway.

Airway management of lingual tonsillar hypertrophy: A narrative review

“…60,66 The incidence of difficult and impossible facemask ventilation was higher in the LTH cases than that reported in the general population (29.6 vs. 1.4% and 1.4% vs. 0.16%, respectively). 69 Facemask ventilation may be more difficult as the LTH may distort the supraglottis, 2,19,23,25,26,36,38,39 or overhang the borders of the epiglottis and cause airway obstruction. 2 Posterior displacement of the tongue may limit airflow from both nasal and oral routes, and an increased thickness of the tongue base is a predictor of difficult face mask ventilation.…”

“…72 However, this may not be possible if the LTH lesion occupies the entire vallecula, 1,7 or causes the epiglottis to be downfolded, retroflexed, immobile or buried. 2,19,23,25,26,36,38,39 In addition, if the tongue is not displaced to the left, the base of the tongue may be compressed distally producing posterior displacement of the epiglottis. 72 Straight blade laryngoscopy has theoretical advantages over Macintosh laryngoscopy for LTH cases: reduced lifting, compression and displacement of the tongue and epiglottis; an improved line of sight (no intrusion as seen with the curved Macintosh blade); and with the retromolar approach, reduction of the intrusion of maxillary structures into the line of sight.…”

“…20 The airway management of some of the LTH cases may be open to criticism, for example, multiple attempts at airway techniques, blind attempts at intubation (in one case causing bleeding), 15 and not performing awake tracheal intubation despite seeing 'enormous' LTH on oral examination. 25 Four cases had known LTH but awake tracheal intubation was not performed. 25,45,52,57 At the risk of hindsight bias, this raises the question whether awake FBI would have avoided subsequent airway complications such as palatal perforation 45 or the need for tracheostomy.…”

“…25 Four cases had known LTH but awake tracheal intubation was not performed. 25,45,52,57 At the risk of hindsight bias, this raises the question whether awake FBI would have avoided subsequent airway complications such as palatal perforation 45 or the need for tracheostomy. 25 This review is limited by being drawn from mainly case reports and a major case series, constituting a lower level of evidence.…”

“…25,45,52,57 At the risk of hindsight bias, this raises the question whether awake FBI would have avoided subsequent airway complications such as palatal perforation 45 or the need for tracheostomy. 25 This review is limited by being drawn from mainly case reports and a major case series, constituting a lower level of evidence. In a previous small case series, the authors found no association between LTH and difficult airways.…”