title: Massive macroglossia after palatoplasty: case report and review of the literature.
abstract: Cleft palates are among the most common birth defects. Serious complications in perioperative airway management after palatoplasty are rare and mostly described in children with preexisting compromise of airway due to craniofacial anomalies. A very uncommon but typical and frightening complication is postoperative extreme, very rapid emergence, and life-threatening macroglossia. While macroglossia usually has its peak within 24-48 h after palatoplasty and resolves spontaneously, we report a patient with massive lingual swelling with complete obstruction of the upper airway on the fifth postoperative day requiring tracheotomy. Swelling only resolved after removing the endotracheal tube after tracheotomy. Next to the description of our case, we discuss standard care procedure in perioperative management of patients with cleft palate to prevent this life-threatening complication after palatoplasty.
  
  
  CONCLUSIONS
  Macroglossia can occur even 3-5 days after surgery and can be maintained by the pressure of the endotracheal tube to the tongue ground. Knowledge and avoidance of these risk factors are as important as early treatment of respiratory compromise.
authors.affiliation: Department of Neonatology and Paediatric Intensive Care, University Hospital of Cologne, Children's Hospital, Kerpener Str. 62, 50937 Cologne, Germany. shino.junghaenel@uk-koeln.de
authors.forename: Shino
authors.initials: S
authors.lastname: Junghaenel
authors.forename: Titus
authors.initials: T
authors.lastname: Keller
authors.forename: Robert
authors.initials: R
authors.lastname: Mischkowski
authors.forename: Jochen
authors.initials: J
authors.lastname: Hinkelbein
authors.forename: Dirk
authors.initials: D
authors.lastname: Beutner
authors.forename: Friederike
authors.initials: F
authors.lastname: Koerber
authors.forename: Peter
authors.initials: P
authors.lastname: Teschendorf
mesh_terms: D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008260:Macroglossia / Q000209:etiology*; D019647:Oral Surgical Procedures; D011183:Postoperative Complications