Neck angioedema after anterior cervical discectomy and fusion with coexistent epiglottic cyst

Abstract

Background: We present a case and reviewed the literature regarding airway obstruction and angioedema after an anterior cervical discectomy and fusion (ACDF). Case Description: A 60-year-old female with degenerative cervical myelopathy and a previously undiagnosed epiglottic cyst underwent a C5–C6 ACDF; notably, the anesthesiologist found an epiglottic cyst when the patient was first intubated. Two hours postoperatively, the patient acutely developed severe neck swelling with airway obstruction due to angioedema. She was immediately treated with hydrocortisone and required a tracheostomy. The edema decreased markedly in the next 12 h and by the 3rd postoperative day it resolved. Three months later, she had no residual medical sequelae. Conclusion: Patients with epiglottic cysts who need cervical spine surgery should either first have the cyst treated or should be closely monitored postoperatively.

Airway Complications After Anterior Cervical Spine Surgery: Etiology and Risk Factors

“…18 Other rare etiologies of airway compromise after ACSS include laryngeal dislocation, improper fitting of a rigid cervical collar, bilateral vocal cord paralysis from recurrent laryngeal nerve (RLN) injury, and severe angioedema. 18,[26][27][28][29] Angioedema is often misdiagnosed due to its rarity but typically presents within 6-12 hours postoperatively. 29 Angioedema may occur as a rare side effect of medications (e.g., risedronate and parecoxib) or due to the presence of a lesion in the laryngopharynx, as is the case with a pre-existing epiglottic cyst; 29 but in most reported cases, it appears to be idiopathic.…”

“…18,[26][27][28][29] Angioedema is often misdiagnosed due to its rarity but typically presents within 6-12 hours postoperatively. 29 Angioedema may occur as a rare side effect of medications (e.g., risedronate and parecoxib) or due to the presence of a lesion in the laryngopharynx, as is the case with a pre-existing epiglottic cyst; 29 but in most reported cases, it appears to be idiopathic. 28 Angioedema typically presents as a postoperative hematoma but is distinguished by associated tongue swelling and a lack of hematoma on imaging.…”