Massive Macroglossia After Posterior Cranial Fossa Surgery: A Case Report

Area of Science:

• Neurosurgery
• Pediatric Critical Care
• Anesthesiology

Background:

• Chiari 1 malformation is a structural defect in the cerebellum.
• Suboccipital craniectomy and C1 laminectomy are surgical procedures to decompress the brainstem and spinal cord.
• Post-operative airway complications can occur, particularly in pediatric patients.

Purpose of the Study:

• To report a rare case of massive macroglossia and airway obstruction following neurosurgery.
• To discuss the clinical course and management strategies for this complication.
• To emphasize the importance of vigilant airway assessment post-extubation.

Main Methods:

• Case report of a 16-year-old male undergoing elective suboccipital craniectomy and C1 laminectomy.
• Intraoperative monitoring and post-extubation airway assessment.
• Videolaryngoscopy to visualize airway structures.
• Management in the pediatric intensive care unit.

Main Results:

• The patient experienced uneventful surgery but developed progressive upper airway obstruction and obtundation post-extubation.
• Videolaryngoscopy revealed significant tongue edema, posterior pharyngeal edema, and blisters on the vocal folds and epiglottis.
• The patient required reintubation and intensive care unit management.

Conclusions:

• Massive macroglossia and airway compromise can be a serious, albeit rare, complication after posterior fossa surgery.
• Close post-operative airway monitoring is crucial in pediatric neurosurgical patients.
• Multidisciplinary management is essential for addressing such critical airway issues.