Lingual tonsil hypertrophy with difficult airway and uncontrollable bleeding

A case of unexpected difficult airway due to lingual tonsil hypertrophy

“…This may result in LTH, probably as a compensatory mechanism due to loss of palatine tonsils (6, 9). LTH most often occurs in adults, especially in atopic individuals, but has also been reported in children (10, 11).…”

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

“…Of note, in the presence of LTH, previous successful intubations do not exclude subsequent difficulty, given the possibility of further lymphoid growth and/or edema (12,14,17,19). There are fewer reported cases of airway compromise caused by LTH in children (22–26). In contrast with our case, the diagnosis of LTH was known before the induction of anesthesia in the majority of these reports (22,24,25).…”

“…There are fewer reported cases of airway compromise caused by LTH in children (22–26). In contrast with our case, the diagnosis of LTH was known before the induction of anesthesia in the majority of these reports (22,24,25). Tracheal intubation was abnormally difficult to achieve in all of these reports, and impossible in one, in which the airway was secured using a laryngeal mask airway (LMA) (23).…”

“…One final consideration applies to the need to carefully evaluate the extent of airway obstruction caused by postoperative edema. The need for prolonged postoperative intubation is described in three other cases of lingual tonsillectomy in children (22,24,25), possibly suggesting an increased incidence of postoperative supraglottic edema in children compared with adults and warranting increased postoperative vigilance.…”

The Pierre Limoges Pediatric Anesthesia Lecture: Tricky problems in pediatric anesthesia

“…Tokumine describes a patient with symptomatic LTH causing, amongst other symptoms, obstructive sleep apnea. 32 The author describes a diffi-R3 cult technique of fibreoptic bronchoscopy under propofol sedation and spontaneous breathing. The procedure was complicated with bleeding from the surface of the lingual tonsils.…”