Massive swelling of the face and tongue

Abstract

SummaryA case of massive swelling of the tongue and face following posterior cranial fossa surgery in the sitting position is described. Prolonged tracheal intubation was required postoperatively. This serious complication appeared to relate to prolongedflexion of the neck.

An Operation in the Park Bench Position Complicated by Massive Tongue Swelling

“…There have been several reported cases of tongue swelling due to venous congestion caused by the surgical position [1, 2], local mechanical compression of the tongue [3, 4], sublingual hematoma secondary to a difficult laryngoscopy and endotracheal intubation [5], and angioedema due to angiotensin converting enzyme inhibitor or Droperidol [6, 7]. Endotracheal intubation was easy in the current case, and neither droperidol nor angiotensin converting enzyme inhibitors were required.…”

Postoperative Acute Submandibular Sialadenitis: A Case Report

“…The submandibular gland duct can also be compressed by an endotracheal tube, fixed on the same side as the Wharton's duct open on the sublingual papilla at the base of the tongue. 7 Sympathetic nervous system activation due to any reason can lead to increased viscosity and secretion, with no outlet leading to stasis. In our case, there was stimulation of the VII cranial nerve around the medulla pons border may have further increased the secretion of the salivary gland, whereas the flow may have been decreased due to dexmedetomidine infusion, an alpha 2 agonist, which may have contributed to the swelling as it has antisialagouge properties.…”

Patient Positioning in Spine Surgery: What Spine Surgeons Should Know?

“…Adequate invasive arterial blood pressure monitoring at the head level contributes to adequate cerebral perfusion pressure [ 79 ]. Oral airway placement combined with extreme neck flexion can result in airway obstruction due to tongue, pharynx and palate swelling [ 78 ]. In this position, it is critical to ensure that careful positioning, padding of pressure points, and extreme neck flexion are avoided [ 86 ].…”

“…Complication rates for sitting cervical procedures are lower (0.7%) than for sitting cranial procedures, with an odds ratio of 0.28 [76]. There are numerous potential complications associated with the sitting position, including venous air embolism (VAE), hypotension, paradoxical air embolism, airway edema, macroglossia, decreased cerebral pressure, pneumocephalus, subdural hematoma dislocation of the elbow, displacement of endotracheal tubes, jugular venous obstruction, compartment syndrome, lumbosacral pressure sores, central cord syndrome, paraplegia, quadriplegia, and common peroneal nerve palsy [77][78][79][80][81][82][83][84][85]. The most common and feared complications of this position are VAE and associated hypotension.…”