Zusammenfassung
Es wird über ein 13 Monate altes Kind berichtet, dass kurz nach Gaumenspaltenverschluss eine lebensbedrohliche Makroglossie mit Atemwegsobstruktion entwickelte. Da die direkte Laryngoskopie unmöglich war, wurde der Atemweg zunächst mithilfe der Larynxmaske gesichert und das Kind anschließend darüber fiberoptisch endotracheal intubiert. Dieser Beitrag beschreibt Inzidenz, Pathophysiologie, klinische Dynamik, Möglichkeiten des anästhesiologischen Notfallmanagements und organisatorische Implikationen dieser sehr seltenen, aber typischen Komplikation aus dem Bereich der Mund-, Kiefer- und Gesichtschirurgie.
Abstract
The case of a 13-month-old child who developed a life-threatening macroglossia with airway obstruction following palatoplasty for a cleft palate is reported. As direct laryngoscopy was not feasible a laryngeal mask (LM) was inserted to secure the airway. Under fiber optic guidance an endotracheal tube was then introduced via the LM. In this article the incidence, pathophysiology, clinical dynamics, options for emergency anesthesia management and organizational implications of this rare but typical complication in the field of oral and craniomaxillofacial surgery are reported.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Abe Y, Yanauchi Y, Nagaro T, Arai T (1996) Massive swelling of the tongue in two patients following the repair of cleft palate. Masui 45:1145–1148
Antony AK, Sloan GM (2002) Airway obstruction following palatoplasty: analysis of 247 consecutive operations. Cleft Palate Craniofac J 39:145–148
Aziz SR, Ziccardi VB (2009) Severe glossal edema after primary palatoplasty. J Oral Maxillofac Surg 67:1326–1328
Bell C, Oh TH, Loeffler JR (1988) Massive macroglossia and airway obstruction after cleft palate repair. Anesth Analg 67:71–74
Bortone L, Ingelmo PM, De Ninno G et al (2006) Randomized controlled trial comparing the laryngeal tube and the laryngeal mask in pediatric patients. Paediatr Anaesth 16:251–257
Chan MT, Chan MS, Mui KS, Ho BP (1995) Massive lingual swelling following palatoplasty. An unusual cause of upper airway obstruction. Anaesthesia 50:30–34
Dell’Oste C, Savron F, Pelizzo G, Sarti A (2004) Acute airway obstruction in an infant with Pierre Robin syndrome after palatoplasty. Acta Anaesthesiol Scand 48:787–789
Gruppo di Studio SIAART „Vie Aeree Difficili“; Frova G, Guarino A, Petrini F et al (2006) Recommendations for airway control and difficult airway management in paediatric patients. Minerva Anesthesiol 72:723–748
Gupta R, Chhabra B, Mahajan RK, Nandini (2001) Macrogossia following palatoplasty causing upper airway obstruction: case report. J Oral Maxillofac Surg 59:940–941
Lee JT, Kingston HG (1985) Airway obstruction due to massive lingual oedema following cleft palate surgery. Can Anaesth Soc J 32:265–267
Reynolds PI, O’Kelly SW (1993) Fiberoptic intubation and the laryngeal mask airway. Anesthesiology 79:1144
Weiss M, Engelhardt T (2010) Proposal for the management of the unexpected difficult pediatric airway. Paediatr Anaesth 20:454–464
Weiss M, Mauch J, Becke K et al (2009) Fibre optic-assisted endotracheal intubation through the laryngeal mask in children. Anaesthesist 58:716–721
Interessenskonflikt
Dr. Neuhäuser, PD Dr. Schmitz, Dr. Welter, Dr Arendt und PD Dr. Bindl erklären, dass kein Interessenkonflikt im Sinne der Richtlinien des International Committee of Medical Journal Editors besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Neuhäuser, C., Welter, J., Arendt, C. et al. Lebensbedrohliche Makroglossie nach Gaumenspaltenverschluss. Anaesthesist 59, 1102–1104 (2010). https://doi.org/10.1007/s00101-010-1786-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00101-010-1786-7