Acute Macroglossia Post Craniotomy in Sitting Position: A Case Report and Proposed Management Guideline

Abstract

Omar Ababneh,1 Subhi Alghanem,1 Abdulrahman Al-Shudifat,2 Lubna Khreesha,3 Salameh Obeidat,4 Isam Bsisu1 1Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, Jordan; 2Division of Neurosurgery, Department of Special Surgery, School of Medicine, The University of Jordan, Amman, Jordan; 3Division of Otolaryngology, Department of Special Surgery, School of Medicine, The University of Jordan, Amman, Jordan; 4Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX, USACorrespondence: Omar AbabnehDepartment of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, PO Box 13046, Amman 11942, JordanTel [phone]Email [email protected]: Macroglossia is a rare life-threatening postoperative complication in patients undergoing neurosurgical operations in a sitting position. It is difficult to identify the cause of macroglossia, which can be considered multifactorial in most patients.Case Presentation: We herein present a case of a 37-year-old female patient who was known to have a posterior occipital lesion (low-grade glioma with pilocytic features) and underwent occipital craniectomy followed by supratentorial approach for debulking of the tumor under general anesthesia in a sitting position. The patient developed upper airway edema along with extreme macroglossia immediately following extubation, with increasing difficulty in ventilation. Re-intubation was impossible, and urgent tracheostomy was performed. In the intensive care unit (ICU), the macroglossia worsened, and the patient developed sepsis with multi-organ failure and died 16 days postoperatively.Conclusion: Acute macroglossia can be a catastrophic postoperative complication, necessitating early identification and a systematic approach to this critical event, in addition to being fully prepared to deal with difficult airway should this complication occur.Keywords: macroglossia, postoperative complication, craniotomy, sitting position, airway obstruction, general anesthesia

Keywords

• macroglossia
• postoperative complication
• craniotomy
• sitting position
• airway obstruction
• general anesthesia.