Severe macroglossia after posterior fossa and craniofacial surgery in children

Bouaoud, Jebrane; Joly, Aline; Picard, A.; Thierry, Briac; Arnaud, Éric; James, Syril; Hennessy, I.; McGarvey, B.; Cairet, Pascale; Vecchione, Antonio; Vergnaud, Estelle; Duracher, Caroline; Khonsari, R.H.

doi:10.1016/j.ijom.2017.12.003

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…Finally, prolonged mechanical ventilation in the prone position may promote swelling of the tongue by gravitational hypostasis. Whether a single factor or combined factors 20 caused the grotesque swelling of the tongue in our case, remains unclear.…”

Section: Discussionmentioning

confidence: 85%

Thinking Out-of-the-Box: A Non-Standard Application of Standard Pulse-Oximetry and Standard Near-Infrared Spectroscopy in a COVID-19 Patient

Schober

Lust

Heunks

et al. 2020

J Intensive Care Med

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Purpose: Purpose of this report is to describe the feasibility of lingual pulse oximetry and lingual near-infrared spectroscopy (NIRS) in a COVID-19 patient to assess lingual tissue viability after several days of mechanical ventilation in the prone position. Materials & Methods: In a COVID-19 ICU-patient, the tongue became grotesquely swollen, hardened and protruding from the oral cavity after 20 h of mechanical ventilation uninterrupted in the prone position. To assess the doubtful viability of the tongue, pulse-oximetric hemoglobin O2-saturation (SpO2; Nellcor, OxiMax MAX-NI, Covidien, MA, USA) and NIRS-based, regional tissue O2-saturation measurements (rSO2; SenSmart, Nonin, MN, USA) were performed at the tongue. Results: At the tongue, regular pulse-oximetric waveforms with a pulse-oximetric hemoglobin O2-saturation (SpO2) of 88% were recorded, i.e. only slightly lower than the SpO2 reading at the extremities at that time (90%). Lingual NIRS-based rSO2 measurements yielded stable tissue rSO2-values of 76-78%, i.e. values expected also in other adequately perfused and oxygenated (muscle-) tissues. Conclusion: Despite the alarming, clinical finding of a grotesquely swollen, rubber-hard tongue and clinical concerns on the adequacy of the tongue perfusion and oxygenation, our measurements of both arterial pulsatility (SpO2) and NIRS-based tissue oxygenation (rSO2) suggested adequate perfusion and oxygenation of the tongue, rendering non-vitality of the tongue, e.g. by lingual venous thrombosis, unlikely. To our knowledge, this is the first clinical report of lingual rSO2 measurement.

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Section: Discussionmentioning

confidence: 85%

Thinking Out-of-the-Box: A Non-Standard Application of Standard Pulse-Oximetry and Standard Near-Infrared Spectroscopy in a COVID-19 Patient

Schober

Lust

Heunks

et al. 2020

J Intensive Care Med

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“…This allows for visualization of the airway and accurate placement of the tube within the trachea. This technique has been utilized by other studies requiring placement of an emergency airway in patients suffering from acute macroglossia [ 15 , 16 ]. Urgent cricothyroidotomy should be reserved as a last option but may be required in the setting of severe airway obstruction, especially if complicated by laryngeal edema [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Acute airway obstruction requiring nasotracheal intubation following hypoglossal neuromonitoring: a case report

et al. 2023

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Background Intraoperative neurophysiological monitoring (IONM) is utilized for both the localization of critical structures and for real time detection and prevention of intraoperative neurological injury. Use of IONM to monitor the hypoglossal nerve is performed during neurosurgical, otolaryngological, and vascular procedures to improve surgical outcomes. There is a paucity of literature describing potential complications of IONM of the hypoglossal nerve, especially with respect to airway compromise. Here we present our findings regarding a case of acute airway obstruction following hypoglossal nerve monitoring. Case Presentation A 54-year-old male was admitted for left far-lateral craniotomy and microsurgical clipping of a left posterior inferior cerebellar artery (PICA) aneurysm. Following induction and intubation but prior to the procedure start, the patient was placed in the ¾ prone position with the left side up and his neck was flexed approximately 10 degrees. He then underwent placement of subdermal needle electrodes into the facial muscles, trapezius muscles, soft palate, and tongue for IONM. The procedure lasted 523 minutes and was completed without complication. However, approximately one hour after emergence from general anesthesia, the patient experienced progressive difficulty breathing secondary to severe lingual swelling. He required emergent placement of a nasotracheal tube guided by a fiberoptic bronchoscope. He remained intubated for 3 days and was treated with dexamethasone, after which the swelling resolved, and the patient was successfully extubated. Conclusions Acute lingual edema is a potentially life-threatening phenomenon that can lead to rapid airway compromise. Generally, causes of acute lingual swelling include hemorrhage, edema, infarction, and infection. In the case described above, we suspect traumatic injury to the tongue’s vascular supply caused a deep tissue hematoma leading to postoperative acute lingual swelling and airway obstruction. With the widespread use of IONM, it becomes essential for providers to be aware that perioperative airway compromise is a potentially life-threatening complication, especially with respect to monitoring of the hypoglossal nerve. Awake fiberoptic nasotracheal intubation can successfully be employed to establish an emergency airway in such situations.

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“…Severe macroglossia due to prolonged prone positioning has been reported after posterior fossa and craniofacial surgery. It can be a lifethreatening condition due to upper airway obstruction if adequate precautions are not followed [9] . Prone positioning has been used as procedure for patients with acute lung injury or ARDS.…”

Section: Discussionmentioning

confidence: 99%

Consecutive Severe Orofacial Complications in Intensive Care Unit Patients: Quincke’s Disease and Macroglossia due to Prolonged Prone Positioning for Management of Acute Respiratory Distress Syndrome

Belfeki¹,

Zayet

Sy³

et al. 2022

European Journal of Case Reports in Internal Medicine

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Critically ill patients admitted into the intensive care units are susceptible to a wide array of complications that can be life-threatening, or lead to long-term complications. Some complications are inherent to the patient’s condition and others are related to therapeutics or care procedure. The prolonged prone positioning and mechanical ventilation devices are the first risk factors for orofacial complications. We report the case of a 47-year-old male patient, with a history of sleep apnoea syndrome, morbid obesity (body mass index of 43 kg/m2), and gastroesophageal reflux disease, presented to the emergency department with recent otorhinolaryngological symptoms of dysphonia and exertional dyspnoea lasting two days, and complicated with Quincke’s disease. First-line treatment consisted of a compilation of intravenous antihistamines and corticosteroids. The patient’s condition worsened. He developed an acute respiratory distress syndrome secondary to ventilator-acquired pneumonia with prone positioning ventilation, complicated by severe macroglossia. Soaked gauze dressings were placed around his tongue. Progressively, the size of his tongue reduced.

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Severe macroglossia after posterior fossa and craniofacial surgery in children

Cited by 9 publications

References 24 publications

Thinking Out-of-the-Box: A Non-Standard Application of Standard Pulse-Oximetry and Standard Near-Infrared Spectroscopy in a COVID-19 Patient

Thinking Out-of-the-Box: A Non-Standard Application of Standard Pulse-Oximetry and Standard Near-Infrared Spectroscopy in a COVID-19 Patient

Acute airway obstruction requiring nasotracheal intubation following hypoglossal neuromonitoring: a case report

Consecutive Severe Orofacial Complications in Intensive Care Unit Patients: Quincke’s Disease and Macroglossia due to Prolonged Prone Positioning for Management of Acute Respiratory Distress Syndrome

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