Lingual tonsillar hypertrophy, an unknown enemy

Marcotegui-Barber, Isabel; Bilbao-Ares, Alejandro; Azcona-Salvatierra, Amaia; Carrascosa-Gil, Andrés; Hualde-Algarra, Andrea; Salvador-Bravo, Miguel

doi:10.1097/cj9.0000000000000108

Cited by 3 publications

(6 citation statements)

References 22 publications

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“…We retrieved 48 articles: 34 in English, 2,5,9,15 –45 nine in Japanese, 46 –54 two in Spanish, 55,56 one in Korean, 57 one in French, 58 and one in Italian. 59 These articles described a total of 89 patients and 92 cases (see Figure 2).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Awake Tracheal Intubation May Be the Best Option For Known S...mentioning

confidence: 99%

“…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.…”

Section: Direct Laryngoscopy Commonly Failed In Lingual Tonsillar Hyp...mentioning

confidence: 99%

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Airway management of lingual tonsillar hypertrophy: A narrative review

Wong,

Sleigh

2023

Anaesth Intensive Care

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Lingual tonsillar hypertrophy is rarely identified on routine airway assessment but may cause difficulties in airway management. We conducted a narrative review of case reports of lingual tonsillar hypertrophy to examine associated patient factors, success rates of airway management techniques and complications. We searched the literature for anaesthetic management of cases with lingual tonsillar hypertrophy. We found 89 patients in various case reports, from which we derived 92 cases to analyse. 64% of cases were assessed as having a normal airway. Difficult and impossible face mask ventilation occurred in 29.6% and 1.4% of cases, respectively. Difficult intubation and failed intubation occurred in 89.1% and 21.7% of cases, respectively. Multiple attempts (up to six) at intubation were performed, with no successful intubation after the third attempt with direct laryngoscopy. Some 16.5% of patients were woken up and 4.3% required emergency front of neck access. Complications included oesophageal intubation (10.9%), bleeding (9.8%) and severe hypoxia (3.2%). Our findings show that severe cases of lingual hypertrophy may cause an unanticipated difficult airway and serious complications, including hypoxic brain damage and death. A robust airway strategy is required which includes limiting the number of attempts at laryngoscopy, and early priming and performance of emergency front of neck access if required. In patients with known severe lingual tonsillar hypertrophy, awake intubation should be considered.

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confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Awake Tracheal Intubation May Be the Best Option For Known S...mentioning

confidence: 99%

Section: Direct Laryngoscopy Commonly Failed In Lingual Tonsillar Hyp...mentioning

confidence: 99%

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Airway management of lingual tonsillar hypertrophy: A narrative review

Wong,

Sleigh

2023

Anaesth Intensive Care

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“…Con referencia a esta estructura, ¿cuál de las siguientes afirmaciones es falsa? 5 A) La hipertrofia de la AL tiene una prevalencia desconocida, pero se ha descrito como una causa frecuente de vía aérea difícil no previsible. B) Se sit ua en la base de la lengua, entre las papilas caliciformes y la epiglotis.…”

Section: Respecto De La Anomalía De Ebstein Es Cierto Queunclassified

Questions and answers

Raffán-Sanabria

2020

Colombian Journal of Anesthesiology

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2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway *

Apfelbaum¹,

Hagberg²,

Connis³

et al. 2021

Anesthesiology

670

547

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The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care, Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.

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Lingual tonsillar hypertrophy, an unknown enemy

Cited by 3 publications

References 22 publications

Airway management of lingual tonsillar hypertrophy: A narrative review

Airway management of lingual tonsillar hypertrophy: A narrative review

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2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway *

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