Prerak Yadav1, Saumil Mandelia2, Himanshu Tyagi3 and Hitesh Garg3
1Clinical Spine Fellow, Spine Surgery Unit, Artemis Hospital, Gurugram, Haryana, India
2Consultant Spine Surgeon, Apollo Hospital, Ahmedabad, India
3Senior Consultant, Spine Surgery Unit, Artemis Hospital, Gurugram, Haryana, India
*Corresponding Author: Hitesh Garg, Senior Consultant, Spine Surgery Unit, Artemis Hospital, Gurugram, Haryana, India.
Received: April 30, 2020; Published: May 27, 2020
Introduction: Post-operative macroglossia is a rare but devastating complication that can occur during any spinal surgery procedure. Very few cases have been reported regarding development of post-operative macroglossia after spine surgery. This complication can be more troublesome in cases of Achondroplasic patients, who are already at high risk because of pre-existing oral anomalies.
Case Report: Here we present a case of 22 year old Achondroplasic female with pre-existing oral cavity anomalies that develops post-operative life threatening macroglossia, after having undergone revision decompression surgery for craniovertebral junction. Occipto-cervical fixation with foramen Magnum decompression and D10 to L2 posterior fixation with decompression was performed in this patient in prone position with less than 500 ml blood loss in less than 4 hours. After failed conservative management and laser assisted tongue reduction, we had to resort to tracheostomy and shifting from oral endotracheal tube to tracheostomy tube to manage this complication. Additionally, the occipitocervical fixation was changed giving slight extension to reduce the venous pressure.
Conclusion: Patients with pre-existing oral cavity anomalies like down syndrome, achondroplasia etc. are at high risk of developing post-operative macroglossia, especially if they are undergoing craniovertebral junction surgery. In these patients, it is preferable to intubate through nasal route rather than oral route. Also, the length of surgery should be kept as short as possible. If two surgical procedures are required in the same patient, best would be to do them in staged manner on different days. Excessive neck flexion during the procedure should be avoided during positioning and craniovertebral fixation surgery, best is to do it in slight extension or neutral alignment of neck. Use of tongue blocks as a protective measure is also encouraged.
Keywords: Post-Operative Macroglossia; Craniovertebral Junction; Achondroplasia
Citation: Hitesh Garg., et al. “Post Operative Macroglossia after Craniovertebral Junction Surgery in Patient with Achondroplasia”. Acta Scientific Clinical Case Reports 1.5 (2020): 17-22.
Copyright: © 2020 Hitesh Garg., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.