Lingual tonsillar hypertrophy, an unknown enemy: a case report

  • Isabel Marcotegui-Barber Anesthesia and Resuscitation Service, Complejo Hospitalario de Navarra, Pamplona, Spain
  • Alejandro Bilbao-Ares Anesthesia and Resuscitation Service, Complejo Hospitalario de Navarra, Pamplona, Spain
  • Amaia Azcona-Salvatierra Anesthesia and Resuscitation Service, Complejo Hospitalario de Navarra, Pamplona, Spain
  • Andrés Carrascosa-Gil Anesthesia and Resuscitation Service, Complejo Hospitalario de Navarra, Pamplona, Spain
  • Andrea Hualde-Algarra Anesthesia and Resuscitation Service, Complejo Hospitalario de Navarra, Pamplona, Spain
  • Miguel Salvador-Bravo Anesthesia and Resuscitation Service, Complejo Hospitalario de Navarra, Pamplona, Spain
Keywords: Tongue, Hypertrophy, Airway Management, Tonsillitis, Airway Obstruction

Abstract

We report an unexpected difficult airway in a patient with unrecognized lingual tonsillar hypertrophy. A 54-year-old hypertensive woman presented for resection of a mediastinal mass under general anesthesia (GA). After induction, mask ventilation was impossible. Laryngeal mask airway (LMA) was used, achieving suboptimal ventilation. Fiberoptic intubation through LMA was attempted but tube advancement was hindered by a protrudingmass. Finally, intubation was achieved using the Frova introducer. After completion of the surgery, the patient was transferred, intubated, to the postanesthesia care unit. Ear, nose, and throat assessment concluded that the mass was a hyper-trophied lingual tonsil. Unexpected lingual tonsillar hypertrophy can complicate GA, making mask ventilation, and even intubation impossible. It is considered a frequent cause of unexpected difficult airway. Diagnosis cannot be made by standard airway physical examination. Once recognized, fiberoptic intubation is mandatory in subsequent surgeries.

References

1. Ovassapian A, Glassenberg R, Randel GI, et al. The unexpected difficult airway and lingual tonsil hyperplasia: a case series and a review of the literature. Anesthesiology 2002;97:124-132.

2. Davies S, Ananthanaryayn C, Castro C. Asymptomatic lingual tonsillar hypertrophy and difficult airway management: a report of three cases. Can J Anaesth 2001;48:1020-1024.

3. Asbjornsen H, Kuwelker M, Softeland E. A case of unexpected difficult airway due to lingual tonsil hypertrophy. Acta Anaes-thesiol Scand 2008;52:310-312.

4. Asai T, Hirose T, Shungu K. Failed tracheal intubation using a laryngoscope and intubating laryngeal mask. Can J Anaesth 2000;47:325-328.

5. Jones DH, Cohle SD. Unanticipated difficult airway secondary to lingual tonsilar hyperplasia. Anesth Analg 1993;77:1285-1288.

6. Henderson K, Abernathy S, Bays T. Lingual tonsillar hypertrophy: the anesthesiologist’s view. Anesth Analg 1994;79:808-818.

7. Renwick J, Ries C. Lingular tonsillar hypertrophy and the difficult airway: due regard for practice guidelines!. Anesth Analg 1995;80:427-434.

8. Patel AB, Davidian E. Complicated airway due to unexpected lingual tonsil hypertrophy. Anesth Prog 2012;59:82-84.

9. Clavier T, Compére V, Hibon R, et al. Lingual tonsil hypertrophy and unanticipated difficult airway management. Ann Fr Anesth Reanim 2011;30:375-379.

10. Arrica M, Crawford M. Complete upper airway obstruction after induction of anesthesia in a child with undiagnosed lingual tonsil hypertrophy. Paediatr Anaesth 2006;16:584-587.

11. Nakazawa K, Ikeda D, Ishikawa S, et al. A case of difficult airway due to lingual tonsillar hypertrophy in a patient with Down’s syndrome. Anesth Analg 2003;97:704-705.

12. Tokumine J, Sugahara K, Ura M, et al. Lingual tonsil hypertrophy with difficult airway and uncontrollable bleeding. Anaesthesia 2003;58:390-391.

13. Shamaa M, Jefferson P, Ball DR. Lingual tonsil hypertrophy: airway management. Anaesthesia 2003;58:1134-1135.

14. Kumar S, Verma N, Agarwal A. Lingual tonsillar hypertrophy: cause of un-anticipated difficult intubation. J Anaesthesiol Clin Pharmacol 2014;30:590-591.

15. Zamudio-Burbano MA, Casas-Arroyave FD. Airway management using ultrasound. Colombian Journal of Anesthesiology 2015;43: 307-313.

16. Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015;115:827-848.

17. Patel A. Facemask ventilation before or after neuromuscular blocking drugs: where are we now? Anesthesia 2014;69:801-815.

18. Combes X, Andriamifidy E, Dufresne P, et al. Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort. Br J Anaesth 2007;99:276-281.

19. Nouraie SA, Giussani DA, Howard DJ, et al. Physiological comparison of spontaneous and positive pressure ventilation in laryngotracheal stenosis. Br J Anaesth 2008;101:419-423.

20. McGuire B, Dalton AJ. Sugammadex, airway obstruction, and drifting across the ethical divide: a personal account. Anaesthesia 2016;71:487-492.

21. Curtis R, Lomax S, Patel B. Use of sugammadex in a ‘can’t intubate, can’t ventilate’ situation. Br J Anaesth 2012;108:612-614.
How to Cite
1.
Marcotegui-Barber I, Bilbao-Ares A, Azcona-Salvatierra A, Carrascosa-Gil A, Hualde-Algarra A, Salvador-Bravo M. Lingual tonsillar hypertrophy, an unknown enemy: a case report. Colomb. J. Anesthesiol. [Internet]. 2019 Oct. 1 [cited 2024 Apr. 17];47(4):245-8. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/31

Downloads

Download data is not yet available.
Published
2019-10-01
How to Cite
1.
Marcotegui-Barber I, Bilbao-Ares A, Azcona-Salvatierra A, Carrascosa-Gil A, Hualde-Algarra A, Salvador-Bravo M. Lingual tonsillar hypertrophy, an unknown enemy: a case report. Colomb. J. Anesthesiol. [Internet]. 2019 Oct. 1 [cited 2024 Apr. 17];47(4):245-8. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/31
Section
Case Report / Case Series

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code

Some similar items: