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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2017; 04(02): 078-084
DOI: 10.4103/jnacc-jnacc-64.16
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Macroglossia in neurosurgery

Melissa Brockerville
1   Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
,
Lakshmikumar Venkatraghavan
1   Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
,
Pirjo Manninen
1   Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
08 May 2018 (online)

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Abstract

Macroglossia, an abnormal swelling of the tongue, is a rare post-operative complication often associated with serious airway obstruction and prolonged intubations. Currently, there is a paucity of information on the true incidence, aetiology, and complications associated with macroglossia. A thorough review of the literature was carried out so as to summarise the characteristics of reported cases of macroglossia and to present potential treatments and preventive strategies. A literature search was conducted in PubMed to identify human case reports of macroglossia after neurosurgical procedures including spine, published in English from 1974 to December 2015. A total of 26 reports with 36 cases of macroglossia were identified. Macroglossia was most commonly reported after sub-occipital and/or posterior fossa craniotomies and spine surgeries in prone or park-bench positions. It is more common after procedures lasting >8 h. The aetiology of macroglossia is multi-factorial and possible mechanisms included local mechanical tongue compression interfering with venous and/or lymphatic drainage, regional venous thrombosis and/or local trauma. Complications included airway obstruction, re-intubation, difficult re-intubation, prolonged intubation and Intensive Care Unit stay and tongue necrosis. Prevention, awareness of the possibility, and early recognition are the best forms of treatment.

Keywords

Macroglossia - neurosurgery - spinal surgery
 

  • REFERENCES

  • 1 Moore JK, Chaudhri S, Moore AP, Easton J. Macroglossia and posterior fossa disease. Anaesthesia 1988; 43: 382-5
    CrossrefPubMedGoogle Scholar
  • 2 Sinha A, Agarwal A, Gaur A, Pandey CK. Oropharyngeal swelling and macroglossia after cervical spine surgery in the prone position. J Neurosurg Anesthesiol 2001; 13: 237-9
    CrossrefPubMedGoogle Scholar
  • 3 Ellis SC, Bryan-Brown CW, Hyderally H. Massive swelling of the head and neck. Anesthesiology 1975; 42: 102-3
    CrossrefPubMedGoogle Scholar
  • 4 Carie CM, White DR, Discolo CM. Postoperative massive tongue edema in craniosynostotic children. Int J Pediatr Otorhinolaryngol 2011; 75: 1173-5
    CrossrefPubMedGoogle Scholar
  • 5 Lam AM, Vavilala MS. Macroglossia: Compartment syndrome of the tongue?. Anesthesiology 2000; 92: 1832-5
    CrossrefPubMedGoogle Scholar
  • 6 Krnacik MJ, Heggeness MH. Severe angioedema causing airway obstruction after anterior cervical surgery. Spine (Phila Pa 1976) 1997; 22: 2188-90
    CrossrefPubMedGoogle Scholar
  • 7 Miura Y, Mimatsu K, Iwata H. Massive tongue swelling as a complication after spinal surgery. J Spinal Disord 1996; 9: 339-41
    PubMedGoogle Scholar
  • 8 Chowdhury T, Gupta N, Rath GP. Macroglossia in a child undergoing posterior fossa surgery in sitting position. Saudi J Anaesth 2012; 6: 85-6
    CrossrefPubMedGoogle Scholar
  • 9 Mayhew JF, Miner M, Katz J. Macroglossia in a 16-month-old child after a craniotomy. Anesthesiology 1985; 62: 683-4
    CrossrefPubMedGoogle Scholar
  • 10 Vermeersch G, Menovsky T, De Ridder D, De Bodt M, Saldien V, Van de Heyning P. Life-threatening macroglossia after posterior fossa surgery: A surgical positioning problem?. B-ENT 2014; 10: 309-13
    PubMedGoogle Scholar
  • 11 El Hassani Y, Narata AP, Pereira VM, Schaller C. A reminder for a very rare entity: Massive tongue swelling after posterior fossa surgery. J Neurol Surg A Cent Eur Neurosurg 2012; 73: 171-4
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Denneny 3rd JC. Postoperative macroglossia causing airway obstruction. Int J Pediatr Otorhinolaryngol 1985; 9: 189-94
    CrossrefPubMedGoogle Scholar
  • 13 Iwuchukwu I, Ardelt A, Cueva W, Reshi R, Goldenberg F, Frank J. Macroglossia associated with brainstem injury. Neurocrit Care 2014; 20: 106-10
    CrossrefPubMedGoogle Scholar
  • 14 Nimjee SM, Wright DR, Agrawal A, McDonagh DL, Husain AM, Britz GW. Tongue swelling and necrosis after brain tumor surgery. Asian J Neurosurg 2012; 7: 214-6
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Teeple E, Maroon J, Rueger R. Hemimacroglossia and unilateral ischemic necrosis of the tongue in a long-duration neurosurgical procedure. Anesthesiology 1986; 64: 845-6
    CrossrefPubMedGoogle Scholar
  • 16 Toyama S, Hoya K, Matsuoka K, Numai T, Shimoyama M. Massive macroglossia developing fast and immediately after endotracheal extubation. Acta Anaesthesiol Scand 2012; 56: 256-9
    CrossrefPubMedGoogle Scholar
  • 17 Kawaguchi M, Sakamoto T, Ohnishi H, Karasawa J. Pharyngeal packs can cause massive swelling of the tongue after neurosurgical procedures. Anesthesiology 1995; 83: 434-5
    CrossrefPubMedGoogle Scholar
  • 18 Kuhnert SM, Faust RJ, Berge KH, Piepgras DG. Postoperative macroglossia: Report of a case with rapid resolution after extubation of the trachea. Anesth Analg 1999; 88: 220-3
    PubMedGoogle Scholar
  • 19 Koizumi H, Utsuki S, Inukai M, Oka H, Osawa S, Fujii K. An operation in the park bench position complicated by massive tongue swelling. Case Rep Neurol Med 2012; 2012: 165860
    PubMedGoogle Scholar
  • 20 Ishiyama T, Murakami N, Takeda T, Yamamoto M. Macroglossia after neck clipping of a VA-PICA (vertebral artery-posterior inferior cerebellar artery) aneurysm. Masui 1990; 39: 503-7
    PubMedGoogle Scholar
  • 21 Barbara DW, Ronan KP, Maddox DE, Warner MA. Perioperative angioedema: Background, diagnosis, and management. J Clin Anesth 2013; 25: 335-43
    CrossrefPubMedGoogle Scholar
  • 22 Perkins JA. Overview of macroglossia and its treatment. Curr Opin Otolaryngol Head Neck Surg 2009; 17: 460-5
    CrossrefPubMedGoogle Scholar
  • 23 Tsung YC, Wu CT, Hsu CH, Yeh CC, Lin SL, Wong CS. Macroglossia after posterior fossa surgery in the prone position – A case report. Acta Anaesthesiol Taiwan 2006; 44: 43-6
    PubMedGoogle Scholar
  • 24 Pivalizza EG, Katz J, Singh S, Liu W, McGraw-Wall BL. Massive macroglossia after posterior fossa surgery in the prone position. J Neurosurg Anesthesiol 1998; 10: 34-6
    CrossrefPubMedGoogle Scholar
  • 25 McAllister RG. Macroglossia – A positional complication. Anesthesiology 1974; 40: 199-200
    CrossrefPubMedGoogle Scholar
  • 26 Tattersall MP. Massive swelling of the face and tongue. A complication of posterior cranial fossa surgery in the sitting position. Anaesthesia 1984; 39: 1015-7
    CrossrefPubMedGoogle Scholar
  • 27 Drummond JC. Macroglossia, deja vu. Anesth Analg 1999; 89: 534-5
    PubMedGoogle Scholar
  • 28 Tamkus A, Rice K. The incidence of bite injuries associated with transcranial motor-evoked potential monitoring. Anesth Analg 2012; 115: 663-7
    PubMedGoogle Scholar
  • 29 Deiner SG, Osborn IP. Prevention of airway injury during spine surgery: Rethinking bite blocks. J Neurosurg Anesthesiol 2009; 21: 68-9
    PubMedGoogle Scholar
  • 30 Munshi CA, Dhamee MS, Gandhi SK. Postoperative unilateral facial oedema: A complication of acute flexion of the neck. Can Anaesth Soc J 1984; 31: 197-9
    CrossrefPubMedGoogle Scholar
  • 31 Sokhal N, Chowdhury T, Goyal K. Postoperative lingual edema is not always a predictor of airway compromise. Saudi J Anaesth 2012; 6: 79-80
    CrossrefPubMedGoogle Scholar
  • 32 Jakobson DJ, Einav S, Krichevsky I, Sprung CL, Sela MS. Traumatic macroglossia: A life-threatening complication. Crit Care Med 1999; 27: 1643-5
    CrossrefPubMedGoogle Scholar