Produção Nacional
Revisado por pares
Severe tongue oedema as a complication of prolonged prone position in a patient with Chiari malformation treated with posterior fossa decompression
2017; Elsevier BV; Volume: 46; Linguagem: Inglês
10.1016/j.ijom.2017.02.1248
ISSN1399-0020
AutoresJoão Luiz Gomes Carneiro Monteiro, Lívia Mirelle Barbosa, Antônio C. Escorel Neto, P. Rocha, Carlos Augusto Pereira do Lago, Demócrito de Barros Miranda-Filho,
Tópico(s)Cerebrospinal fluid and hydrocephalus
ResumoWe describe a case of a 60-year-old obese male patient diagnosed with Chiari malformation, a condition that involves the herniation of the cerebellar structures into the medullary canal. In order to improve neurological symptoms, he was submitted to posterior fossa decompression by the Neurosurgery team; a surgery that involves the patient in the prone position for extended time. At the end of the procedure and in the awakening from anaesthesia, the patient's tongue was noted to be large and swollen and protruded out of the oral cavity causing an airway obstruction. Tracheostomy was performed after several attempts to intubate and the patient was sent to the intensive care unit. The patient was medicated with steroids and the tongue was wrapped with a wet bandage to prevent desiccation. Extraction of the few mandibular teeth was required due to local trauma and possibly causing the oedema to increase. The tongue swelling regressed in approximately thirty days. Macroglossia is a rare complication of prolonged surgery in the prone position and is possibly caused by regional venous obstruction due to excessive neck flexion further leading to a reperfusion injury. The patient is also obese and has a short neck inherent to his malformation, factors that are also described to cause venous congestion.
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