Complete upper airway obstruction after induction of anesthesia in a child with undiagnosed lingual tonsil hypertrophy

Abstract

We present a case of a 9-year-old patient with previously undiagnosed lingual tonsil hypertrophy (LTH) that caused sudden and complete airway obstruction and inability to ventilate on induction of anesthesia. More frequently described in adults than in children, LTH can complicate mask ventilation, intubation or both, with the potential for catastrophic consequences.

The effects of Anesthesia and opioids on the upper airway: A systematic review

“…Sevoflurane has dose‐dependent effects, with decreasing phasic inspiratory genioglossus activity seen with increasing depth of sevoflurane anesthesia and no difference in tonic activity . Sevoflurane can also decrease airway patency, especially during inspiration . In a study using both sevoflurane and nitrous oxide for induction and propofol for anesthesia maintenance, the greatest narrowing was seen at the soft palate level, and the airway dimensions changed when sedated versus awake.…”

Lingual tonsillectomy with the PlasmaBlade

“…13,14 Thus, a detailed airway game plan should be developed in close cooperation with the anesthesia team, with multiple management options available that can be escalated quickly if needed. During induction, it is ideal to maintain spontaneous ventilation and avoid muscle relaxants.…”

Radiology Quiz Case 3: Diagnosis

“…1,2 Several cases of acute airway obstruction caused by LTH have been reported in the literature. 1,6,7 It should be noted, however, that airway obstruction due to LTH is a very uncommon occurrence. 1 Children may have more of a predilection for acute airway obstruction as a result of an acute inflammatory process.…”