Postoperative massive tongue edema in craniosynostotic children

Although rarely encountered in the clinical setting, massive tongue edema is a known phenomenon that can occur in craniosynostotic children in the postoperative period. In 1998, Kunhert described an encounter with an adolescent patient with Crouzon syndrome who required craniectomy for complications associated with Chairi malformation [1]. Following her procedure she had rapid tongue edema which was felt to be secondary to obstruction of the venous drainage of the tongue. Despite extensive workup and unsuccessful medical attempts to reduce the swelling, she was extubated with rapid resolution of the tongue edema [1].

In our facility, two children with underlying craniofacial diagnoses underwent elective surgical procedures. During their postoperative course, they encountered postoperative massive tongue swelling which ultimately required tracheotomy to relieve the compression and upper airway obstruction.

We describe the clinical manifestations, treatment, and postoperative outcomes identified in these two cases.