Upper airway obstruction secondary to a lingual tonsil

Lingual tonsils hypertrophy; a cause of obstructive sleep apnea in children after adenotonsillectomy: Operative problems and management

“…LMA was successfully inserted and proper ventilation was resumed, then sevoflurane discontinued and the patient was awakened and the child was subjected to awake fiberoptic nasotracheal intubation. However, the use of LMA in patients with LTH is controversial, some published case reports revealed that its use was successful in managing the upper airway obstruction in patients with LTH [19,24], while some authors reported that LMA may cause edema and bleeding of the airway specially with repeated insertion attempts between several intubation trials as the blind insertion of LMA may be traumatic to the lingual tissues [19,21,25]. The upper airway edema and bleeding render the fiberoptic intubation more difficult, so in our study, we limited the use of LMA and considering it as a last option in cases of cannot intubate cannot ventilate via the face mask.…”

Unexpected difficult intubation due to lingual tonsillar hyperplasia in a thoracotomy patient: intubation with the double-lumen tube using stylet and fiberoptic bronchoscopy

“…Although there are several reports of successful use of the LMA in patients with upper airway obstruction secondary to lingual tonsillar hyperplasia [6,9,17], its use is controversial [10,18]. Fundingsland and Benumof [7] reported a case in which the LMA was of only limited efficacy as a ventilatory conduit.…”

A Case of Difficult Airway Due to Lingual Tonsillar Hypertrophy in a Patient with Down???s Syndrome

“…Because the presence of LTH may be overlooked, the condition may be unanticipated and manifest on the induction of anesthesia (5)(6)(7)(8)(9)(10)(11). Indeed, a case report has described cerebral anoxia resulting in patient death because of the "cannot intubate-cannot ventilate" situation (11).…”

“…Lingual tonsillar hypertrophy (LTH) is a relatively rare form of lymphoid hyperplasia, but it may cause lifethreatening airway obstruction (3,4). Generally, LTH may also be detected by the presence of an unanticipated airway difficulty during anesthesia (5)(6)(7)(8)(9)(10)(11). Airway management of symptomatic LTH in patients with Down's syndrome may be challenging because of the patient's lack of cooperation with airway management and underlying complications.…”