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Maddali MM, Al Dafaei OA, Al Wahaibi MMS, Munasinghe TD. Failed Tracheal Extubation Due to Transient Isolated Macroglossia in a Child. Ann Card Anaesth 2024; 27:96-97. [PMID: 38722137 PMCID: PMC10876128 DOI: 10.4103/aca.aca_108_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 05/12/2024] Open
Affiliation(s)
- Madan M. Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman
| | - Omar A. Al Dafaei
- Pediatric Intensive Care, National Heart Center, Royal Hospital, Muscat, Oman
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2
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Mañón VA, Chubb D, Farach LS, Karam R, Farach-Carson MC, Vigneswaran N, Saluja K, Young S, Wong M, Melville JC. Massive macroglossia, a rare side effect of COVID-19: clinical, histologic, and genomic findings in COVID-19-positive versus COVID-19-negative patients. Oral Maxillofac Surg 2022; 26:613-618. [PMID: 34981214 PMCID: PMC8722658 DOI: 10.1007/s10006-021-01031-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022]
Abstract
Purpose The primary purpose of this study is to identify if there is an underlying genetic predisposition for COVID-related macroglossia and if this susceptibility is higher among individuals of African heritage. Secondary objectives include determining if genetic testing of COVID-infected patients who are intubated and prone could identify patients with higher susceptibility to the development of macroglossia. Methods A retrospective chart review was completed for each patient, and prospectively, genetic and histopathologic analyses were completed. Whole-exome sequencing was completed on two patients; immunohistochemistry was completed on the COVID-positive tissue samples. Results Histopathology of the COVID-positive patient revealed significant peri-lymphocytic infiltrate, which was absent in the COVID-negative patient. Immunohistochemistry confirmed the presence of immune cells. Results from the whole-exome sequencing were inconclusive. Conclusion The findings of this study are consistent with others that have observed a lymphocytic infiltrate in the organs of patients infected with SARS-CoV-2. On histology, IHC highlighted a CD45 + predominance, indicating that a robust immune response is present in the tissues. The pathobiology of this phenomenon and its role in the development and/or persistence of massive macroglossia requires further study.
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Affiliation(s)
- Victoria A Mañón
- Bernard and Gloria Pepper Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, TX, 77054, Houston, USA.
| | - David Chubb
- Bernard and Gloria Pepper Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, TX, 77054, Houston, USA
| | - Laura S Farach
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center, Houston, USA
| | - Rachid Karam
- Department of Research and Development, Ambry Genetics, Aliso Viejo, CA, 92656, USA
| | - Mary C Farach-Carson
- Department of Diagnostic and Biomedical Sciences, The University of Texas at Houston, Houston, USA
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical Sciences, The University of Texas at Houston, Houston, USA
| | - Karan Saluja
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, Houston, USA
| | - Simon Young
- Bernard and Gloria Pepper Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, TX, 77054, Houston, USA
| | - Mark Wong
- Bernard and Gloria Pepper Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, TX, 77054, Houston, USA
| | - James C Melville
- Head and Neck Oncologic and Microvascular Reconstructive Surgery, Bernard and Gloria Pepper Katz Department of Oral & Maxillofacial Surgery Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, Houston, USA
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3
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Salik I, Namkoong S, Lisov C, Lederman D, Abramowicz AE. Tongue injury associated with motor evoked potential monitoring: Causes, prevention and treatment options. J Clin Anesth 2021; 78:110617. [PMID: 34872826 DOI: 10.1016/j.jclinane.2021.110617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Irim Salik
- Department of Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America.
| | - Shinae Namkoong
- Department of Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America
| | - Cesar Lisov
- Department of Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America
| | - Debra Lederman
- Department of Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America
| | - Apolonia E Abramowicz
- Department of Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America
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4
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Gupta A, Sarma R, Gupta N, Kumar R. Current practices and beliefs regarding the use of oropharyngeal throat pack in India: A nationwide survey. Indian J Anaesth 2021; 65:241-247. [PMID: 33776116 PMCID: PMC7989489 DOI: 10.4103/ija.ija_1376_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/04/2021] [Accepted: 01/23/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anju Gupta
- Department of Anaesthesiology, Pain Medicine and Intensive Care, AIIMS, New Delhi, India
| | - Riniki Sarma
- Department of Onco-Anaesthesiology and Palliative Medicine, AIIMS, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesiology and Palliative Medicine, AIIMS, New Delhi, India
| | - Rakesh Kumar
- Department of Anaesthesiology, SGT Medical College and Research Institute, Gurugram, Haryana, India
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5
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Andrews E, Lezotte J, Ackerman AM. Lingual compression for acute macroglossia in a COVID-19 positive patient. BMJ Case Rep 2020; 13:e237108. [PMID: 32675133 PMCID: PMC10577785 DOI: 10.1136/bcr-2020-237108] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/25/2022] Open
Abstract
We describe a 40-year-old woman with severe, persistent macroglossia following prone positioning as part of treatment for COVID-19. We used the treatment method of lingual compression with satisfactory results.
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Affiliation(s)
- Erickson Andrews
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jonathan Lezotte
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Adam M Ackerman
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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6
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Alfiky M, Margalani O, Rajeh A, Alghamdi F, Abu Suliman O, Muathen S, Elmorsy S. Nasopharyngeal versus hypopharyngeal packing during sino-nasal surgeries: Randomised controlled trial. Clin Otolaryngol 2018; 43:1235-1241. [DOI: 10.1111/coa.13132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2018] [Indexed: 12/01/2022]
Affiliation(s)
- M.G. Alfiky
- Head, Neck and Skull Base Center; King Abdullah Medical City; Makkah Saudi Arabia
- Department of Otolaryngology; Cambridge University Hospitals; Cambridge UK
| | - O.A. Margalani
- Umm Al-Qura University College of Medicine; Makkah Saudi Arabia
| | - A.F. Rajeh
- Head, Neck and Skull Base Center; King Abdullah Medical City; Makkah Saudi Arabia
| | - F.E. Alghamdi
- Head, Neck and Skull Base Center; King Abdullah Medical City; Makkah Saudi Arabia
| | - O.A. Abu Suliman
- Head, Neck and Skull Base Center; King Abdullah Medical City; Makkah Saudi Arabia
| | - S.H. Muathen
- King Abdulaziz Medical City; Jeddah Saudi Arabia
| | - S.A. Elmorsy
- Head, Neck and Skull Base Center; King Abdullah Medical City; Makkah Saudi Arabia
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7
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The use of throat packs in pediatric cleft lip/palate surgery: a retrospective study. Clin Oral Investig 2018; 22:3053-3059. [PMID: 29473105 PMCID: PMC6224011 DOI: 10.1007/s00784-018-2387-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 02/08/2018] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Throat packs are commonly used to prevent ingestion or aspiration of blood and other debris during cleft lip/palate surgery. However, dislodgement or (partial) retainment after extubation could have serious consequences. The aim of the present study was to investigate the effect of omitting pharyngeal packing during cleft lip/palate surgery on the incidence of early postoperative complications in children. MATERIALS AND METHODS A retrospective study was performed on all children who underwent cleft lip/palate surgery at the Wilhelmina Children's Hospital. This study compared the period January 2010 through December 2012 when pharyngeal packing was applied according to local protocol (group A) with the period January 2013 till December 2015 when pharyngeal packing was no longer applied after removal from the protocol (group B). Data were collected for sex, age at operation, cleft lip/palate type, type of repair, lateral incisions, length of hospital stay, and complications in the first 6 weeks after surgery. Early complications included wound dehiscence, postoperative bleeding, infection, fever, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI). RESULTS This study included 489 cleft lip/palate operations (group A n = 246, group B n = 243). A total of 39 (15.9%) early complications were recorded in group A and a total of 40 (16.5%) in group B. There were no significant differences (P = 0.902) in complications between the two groups; however, there was a significant difference (P < 0.001) in length of hospital stay between the two groups (group A 3.6 days vs group B 3.2 days). CONCLUSION Omitting routine placement of throat packs in cleft lip/palate surgery was not associated with an increased early postoperative complication rate. Therefore, the traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned. CLINICAL RELEVANCE The traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.
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Bouaoud J, Joly A, Picard A, Thierry B, Arnaud E, James S, Hennessy I, McGarvey B, Cairet P, Vecchione A, Vergnaud E, Duracher C, Khonsari RH. Severe macroglossia after posterior fossa and craniofacial surgery in children. Int J Oral Maxillofac Surg 2018; 47:428-436. [PMID: 29301676 DOI: 10.1016/j.ijom.2017.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/23/2017] [Accepted: 12/12/2017] [Indexed: 11/28/2022]
Abstract
Massive swelling of the tongue can occur after posterior fossa and craniofacial surgery. Several hypotheses have been proposed to explain the occurrence of such severe postoperative macroglossia, but this phenomenon is still poorly understood. Severe postoperative macroglossia can be a life-threatening condition due to upper airway obstruction. Three cases of severe postoperative macroglossia that occurred after cervical spine, craniofacial, and posterior fossa surgical procedures are reported here. These cases required specialized maxillofacial management and a prolonged stay in the intensive care unit. Causal factors involved in this condition are reported, in order to highlight appropriate prevention and treatment options adapted to the management of paediatric patients. An overview of the current literature on severe postoperative macroglossia in paediatric populations is also provided.
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Affiliation(s)
- J Bouaoud
- Assistance Publique - Hôpitaux de Paris, Service de Chirurgie Maxillo-faciale et Plastique, Hôpital Necker Enfants-Malades, Paris, France
| | - A Joly
- Assistance Publique - Hôpitaux de Paris, Service de Chirurgie Maxillo-faciale et Plastique, Hôpital Necker Enfants-Malades, Paris, France; Université Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - A Picard
- Assistance Publique - Hôpitaux de Paris, Service de Chirurgie Maxillo-faciale et Plastique, Hôpital Necker Enfants-Malades, Paris, France; Université Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - B Thierry
- Université Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Assistance Publique - Hôpitaux de Paris, Service d'Oto-rhino-laryngologie et Chirurgie Cervico-faciale Pédiatriques, Hôpital Necker Enfants-Malades, Paris, France
| | - E Arnaud
- Assistance Publique - Hôpitaux de Paris, Service de Neurochirurgie et Chirurgie Crânio-faciale, Hôpital Necker Enfants-Malades, Paris, France
| | - S James
- Université Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Assistance Publique - Hôpitaux de Paris, Service de Neurochirurgie et Chirurgie Crânio-faciale, Hôpital Necker Enfants-Malades, Paris, France
| | - I Hennessy
- Paediatric Anaesthesia, Children's University Hospital, Dublin, Ireland
| | - B McGarvey
- Paediatric Anaesthesia, Children's University Hospital, Dublin, Ireland
| | - P Cairet
- Assistance Publique - Hôpitaux de Paris, Service d'Anesthésie et de Réanimation, Hôpital Necker Enfants-Malades, Paris, France
| | - A Vecchione
- Assistance Publique - Hôpitaux de Paris, Service d'Anesthésie et de Réanimation, Hôpital Necker Enfants-Malades, Paris, France
| | - E Vergnaud
- Assistance Publique - Hôpitaux de Paris, Service d'Anesthésie et de Réanimation, Hôpital Necker Enfants-Malades, Paris, France
| | - C Duracher
- Assistance Publique - Hôpitaux de Paris, Service d'Anesthésie et de Réanimation, Hôpital Necker Enfants-Malades, Paris, France
| | - R H Khonsari
- Assistance Publique - Hôpitaux de Paris, Service de Chirurgie Maxillo-faciale et Plastique, Hôpital Necker Enfants-Malades, Paris, France; Université Sorbonne Paris Cité, Université Paris Descartes, Paris, France.
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9
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Persistent Acute Onset Macroglossia Treated with Compression Therapy. Case Rep Otolaryngol 2017; 2017:6402413. [PMID: 29085692 PMCID: PMC5611878 DOI: 10.1155/2017/6402413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/13/2017] [Indexed: 12/02/2022] Open
Abstract
Acute macroglossia, while rare and often limited in duration, can present significant management challenges. The anatomic position of the tongue, which can result in airway compromise in cases of enlargement, contributes significantly to difficulty with management. We review several management options for persistent acute onset lingual macroglossia and present a novel noninvasive management technique in a case which was refractory to several strategies.
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10
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Suhitharan T, Seevanayagam S, Parker FC, Teoh WHL. Acute unilateral submandibular gland swelling associated with the laryngeal mask airway. Singapore Med J 2015; 54:e236-9. [PMID: 24356762 DOI: 10.11622/smedj.2013248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We describe a rare complication of acute unilateral submandibular gland swelling following the use of laryngeal mask airway (LMA) in two patients with otherwise uneventful perioperative airway management. This is likely to be a consequence of the pressure exerted by the airway cuff on the tissues within the submandibular triangle. As this complication is rarely reported, its true incidence may in fact be higher, suggesting a need for greater attention on LMA cuff pressures and degree of cuff inflation. We discuss the presenting clinical features, pathophysiology and utilisation of ultrasonographic confirmation of sialadenopathy, and review the current anaesthetic literature to raise awareness of this unusual and under-reported complication of LMA. This complication can be mitigated by incorporating routine manometric checks and limiting intracuff pressures to < 60 cmH2O, potentially avoiding LMA insertions in patients with sialolithiasis and avoiding the use of nitrous oxide.
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Affiliation(s)
- Thangavelautham Suhitharan
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - Sathyendran Seevanayagam
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - Francis Christopher Parker
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - Wendy Hui Ling Teoh
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
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11
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Raut MS, Maheshwari A. Difficult extubation after large tongue swelling in intensive care unit. Indian J Crit Care Med 2014; 18:256. [PMID: 24872660 PMCID: PMC4033864 DOI: 10.4103/0972-5229.130583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Monish S Raut
- Department of Cardiac Anesthesia, Dharam Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Maheshwari
- Department of Cardiac Anesthesia, Dharam Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
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12
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TOYAMA S, HOYA K, MATSUOKA K, NUMAI T, SHIMOYAMA M. Massive macroglossia developing fast and immediately after endotracheal extubation. Acta Anaesthesiol Scand 2012; 56:256-9. [PMID: 22103631 DOI: 10.1111/j.1399-6576.2011.02575.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2011] [Indexed: 11/30/2022]
Abstract
We report an unusual case of massive macroglossia that developed very rapidly after neurosurgery in the park bench position with neck flexion. A few minutes after endotracheal extubation, massive macroglossia was noticed with marked protrusion of the tongue from the oral cavity. The patient's hospital stay was prolonged due to difficulty in speaking and eating. Macroglossia is a rare complication; however, it may cause life-threatening airway obstruction. It is important to be prepared for managing post-operative macroglossia and keep in mind that it may develop rapidly, especially after prolonged surgery performed with sustained neck flexion. The patient should be informed of the risk of macroglossia and the associated problems prior to the operation.
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Affiliation(s)
- S. TOYAMA
- Department of Anesthesiology; Teikyo University Chiba Medical Center; Ichihara; Japan
| | - K. HOYA
- Department of Neurosurgery; Teikyo University Chiba Medical Center; Ichihara; Japan
| | - K. MATSUOKA
- Department of Anesthesiology; Teikyo University Chiba Medical Center; Ichihara; Japan
| | - T. NUMAI
- Department of Anesthesiology; Teikyo University Chiba Medical Center; Ichihara; Japan
| | - M. SHIMOYAMA
- Department of Anesthesiology; Teikyo University Chiba Medical Center; Ichihara; Japan
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13
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Korkut AY, Erkalp K, Erden V, Teker AM, Demirel A, Gedikli O, Saidoglu L. Effect of pharyngeal packing during nasal surgery on postoperative nausea and vomiting. Otolaryngol Head Neck Surg 2010; 143:831-6. [PMID: 21109086 DOI: 10.1016/j.otohns.2010.08.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/16/2010] [Accepted: 08/25/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of pharyngeal packing in reducing postoperative nausea and vomiting (PONV) after nasal surgery by taking into consideration the surgery types. STUDY DESIGN A prospective, randomized, controlled trial. SETTING A tertiary referral center. SUBJECTS AND METHODS After the study was approved by the local ethics committee, this study was conducted in the Otorhinolaryngology clinic with the collaboration of the Anesthesiology clinic. The development of PONV within 24 hours after surgery was evaluated in patients who were applied a pharyngeal pack (Group 1) or not (Group 2) during nasal surgery. RESULTS There were 104 adult patients for routine nasal surgery included in the current study, yielding 100 (group 1, n = 50; group 2, n = 50) evaluable subjects. No significant difference was found in the incidence of PONV between the two groups at two (P = 0.41), four (P = 0.54), eight (P = 0.51), and 24 hours. According to surgery type, the incidence of PONV after two hours was 71 percent in septorhinoplasty, 68 percent in endoscopic sinus surgery, and 50 percent in septoplasty; after four hours it was 59 percent in septorhinoplasty, 53 percent in endoscopic sinus surgery, and 37 percent in septoplasty; and after eight hours it was 35 percent in septorhinoplasty, 39 percent in endoscopic sinus surgery, and 21 percent in septoplasty. PONV was not seen at 24 hours. Compared to the septoplasty group for which pharyngeal packing was used, significantly lower rates of PONV at four and eight hours were found in the septoplasty group in which pharyngeal packing was not used (P = 0.02). CONCLUSION Pharyngeal packing in nasal surgery has no impact on PONV.
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Affiliation(s)
- Arzu Yasemin Korkut
- Department of Otorhinolaryngology, Vakif Gureba Training and Research Hospital, Istanbul, Turkey.
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14
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The benefits of hypopharyngeal packing in nasal surgery: a pilot study. Ir J Med Sci 2010; 180:181-3. [DOI: 10.1007/s11845-010-0601-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 09/27/2010] [Indexed: 11/24/2022]
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15
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Erkalp K, Korkut YA, Meric A, Kahya V, Gedikli O, Su OK, Saitoglu L. Pharyngeal packing is a predisposing factor for postoperative aphthous stomatitis in nasal surgery. Otolaryngol Head Neck Surg 2010; 142:672-6. [PMID: 20416454 DOI: 10.1016/j.otohns.2009.12.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 12/17/2009] [Accepted: 12/22/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate whether pharyngeal packing is a predisposing factor for the development of postoperative aphthous stomatitis in nasal surgery. STUDY DESIGN A prospective, randomized, controlled trial. SETTING A tertiary referral center. SUBJECTS AND METHODS After the study was approved by the local ethics committee, 100 adult patients scheduled for routine nasal surgery were enrolled. The development of postoperative aphthous lesions within three days after surgery was evaluated in patients in whom a pharyngeal pack was (Group 1) or was not (Group 2) applied during nasal surgery. RESULTS In Group 1, the presence of pharyngeal pack increased the risk for postoperative oral mucosal aphthae development by 4.64 times (P = 0.02, RR = 4.64, 95% CI = 1.22-17.91). No significant associations were found between postoperative oral mucosal aphthae development and sex (P = 1), age (P = 0.69), height (P = 0.73), weight (P = 0.22), or duration of surgery (P = 0.47) in Group 1. CONCLUSION Pharyngeal packing during nasal surgery increases postoperative morbidity by leading to the development of painful oral aphthous lesions.
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Affiliation(s)
- Kerem Erkalp
- Department of Anesthesiology, Vakif Gureba Training and Research Hospital, Istanbul, Turkey
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16
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17
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Basha SI, McCoy E, Ullah R, Kinsella JB. The efficacy of pharyngeal packing during routine nasal surgery--a prospective randomised controlled study. Anaesthesia 2007; 61:1161-5. [PMID: 17090236 DOI: 10.1111/j.1365-2044.2006.04868.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The efficacy of pharyngeal packing in the prevention of postoperative nausea and vomiting (PONV) in patients undergoing nasal surgery was evaluated in a prospective randomised controlled study. The effect of the presence of the pharyngeal pack on the incidence of postoperative sore throat was also assessed. One hundred patients were randomly allocated to one of two groups; the first had packing and the second received no packing. The placement of a pharyngeal pack was found to have no effect on the incidence of PONV but was associated with a significantly increased incidence of sore throat. The absence of a pharyngeal pack was not associated with an increase in postoperative aspiration or vomiting. We conclude that the routine placement of pharyngeal packs during uncomplicated nasal surgery has no effect on the incidence of PONV and will increase the incidence of postoperative sore throat.
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Affiliation(s)
- S I Basha
- The Royal Victoria Hospital, Belfast, Northern Ireland, UK.
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18
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Kotil K, Yavasca P, Bilge T. Postoperative Massive Macroglossia in Klippel–Feil Syndrome After Posterior Occipitocervical Fixation Surgery in the Sitting Position. ACTA ACUST UNITED AC 2006; 19:226-9. [PMID: 16770225 DOI: 10.1097/01.bsd.0000194054.79924.bd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postoperative macroglossia is a very rare complication associated with neurosurgical procedures. There have only been 16 cases reported in the literature. With regard to spine surgery, however, only two cases have been reported. The first report was a case where the complication of postoperative macroglossia occurred during occipitocervical spine surgery in a sitting position. In this second documented incident, we report a case of massive macroglossia, in a 44-year-old man, following posterior craniocervical fixation and fusion surgery performed in a sitting position. The patient had Klippel-Feil syndrome with basilar invagination preoperatively. Postoperative macroglossia was treated by partial glossectomy, because medical management (anti-edema therapy) failed. This complication is a life-threatening complication and must be treated promptly. Diverse etiologic mechanisms are discussed along with preventive and therapeutic measures.
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Affiliation(s)
- Kadir Kotil
- Department of Neurosurgery, Haseki Educational and Research Hospital, 34-14 Kadikoy, Istanbul, Turkey.
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19
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Sinha A, Agarwal A, Gaur A, Pandey CK. Oropharyngeal swelling and macroglossia after cervical spine surgery in the prone position. J Neurosurg Anesthesiol 2001; 13:237-9. [PMID: 11426099 DOI: 10.1097/00008506-200107000-00010] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An unusual case of massive oropharyngeal swelling and macroglossia occurring after cervical spine surgery performed on a patient in the prone position is described. Possible etiological factors are reviewed, and measures to prevent these complications are suggested.
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Affiliation(s)
- A Sinha
- Department of Anesthesiology and Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Kuhnert SM, Faust RJ, Berge KH, Piepgras DG. Postoperative macroglossia: report of a case with rapid resolution after extubation of the trachea. Anesth Analg 1999; 88:220-3. [PMID: 9895096 DOI: 10.1097/00000539-199901000-00041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S M Kuhnert
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Spiekermann BF, Stone DJ, Bogdonoff DL, Yemen TA. Airway management in neuroanaesthesia. Can J Anaesth 1996; 43:820-34. [PMID: 8840062 DOI: 10.1007/bf03013035] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Airway management in neurosurgical patients presents unique challenges to the anaesthetist. This review will consider specific approaches to numerous problems in airway management related to logistical, physiological and anatomical concerns. The goal is to provide a clinically oriented and practical discussion regarding issues of airway management in neurosurgical patients. SOURCE The recent literature has been reviewed regarding airway management options and related perioperative complications in the neurosurgical population. This is interlaced with approaches to many of the problems and their solutions based on experience gained in a very busy university neurosurgical practice over the past decade. PRINCIPAL FINDINGS Specific pathophysiological alterations in the neurosurgical patient influence the technique chosen for securing an airway. These relate to the presence of increased intracranial pressure, intracranial aneurysms or arteriovenous malformations. Other important disorders influencing airway management include severe coronary artery disease, acromegaly and congenital airway difficulties. Stereotactic neurosurgery and conscious sedation for various neurosurgical procedures also provide unique challenges. There are other considerations unique to the neurosurgical patient such as intra-and postoperative airway obstruction and the timing of postoperative extubation. CONCLUSION The demands for airway management in neuroanaesthesia require expertise in the various modes of securing the airway while considering the patient's physiological requirements as well as the unique surgical demands.
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Affiliation(s)
- B F Spiekermann
- Department of Anesthesiology, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
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