Assessment of tongue depressor-related tongue swelling in pediatric patients with ultrasonography: A prospective, case-controlled observational study

Adenoidectomy is one of the most common surgeries performed in children. The tongue depressor is being routinely used during adenoidectomy exerts high mechanical pressure on the tongue. We aimed to discover tongue swelling created by the compression of tongue depressor by using ultrasonography (USG) in pediatric patients who were undertaken adenoidectomy. Thirty-four patients who were undertaken adenoidectomy were involved in the study group. In the control group, 33 patients who were undertaken pediatric surgery were involved. The tongue surface area (TSA) measurement was achieved for two times. In the study group, TSA1 was performed immediately following intubation, prior to the installment of the tongue depressor, TSA2 was performed following the removal of the tongue depressor however prior to extubation. In the control group, TSA1 was performed immediately following intubation, TSA2 was performed prior to extubation. An important correlation was noticed among the severity of tongue swelling (defined as TSA2 - TSA1 ) (P = 0.000) and tongue depressor. Tongue depressor may provoke tongue swelling in adenoidectomy procedures that can be shown with USG. This tongue swelling seems to be a result of the pressure applied by the tongue depressor. Tongue depressor related tongue swelling may cause respiratory complications in patients with already restricted airway passage even if the patients are fully awake. The tongue swelling in pediatric patients under adenoidectomy surgeries was demonstrated for the first time in the literature by USG.

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1. Bhattacharyya N. Ambulatory pediatric otolaryngologic procedures in the United States: characteristics and perioperative safety. Laryngoscope. 2010;120:821-5.

2. Gabriel OT, Oyebanji O. A review and outcome of adenoidectomy performed in resource limited settings. Indian J Otolaryngol Head Neck Surg. 2019;71:1-4.

3. Sjogren PP, Thomas AJ, Hunter BN, et al. Comparison of pediatric adenoidectomy techniques. Laryngoscope. 2018;128:745-9.

4. Rosen GM, Muckle RP, Mahowald MW, et al. Postoperative respiratory compromise in children with obstructive sleep apnea syndrome: can it be anticipated? Pediatrics. 1994;93:784-8.

5. Tanaka N, Ibuki T, Araki A, et al. Airway obstruction caused by massive swelling of the tongue following bilateral tonsillectomy for sleep apnea syndrome. Masui. 2006;55:464-7.

6. Nasr VG, Bitar MA, Chehade JM, et al. Postoperative severe uvular edema following tonsillectomy in a child with a history of obstructive sleep apnea. Paediatr Anaesth. 2008;18:673-5.

7. Wojtczak JA. Submandibular sonography: assessment of hyomental distances and ratio, tongue size, and floor of the mouth musculature using portable sonography. J Ultrasound Med. 2012;31:523-8.

8. Onal M, Colpan C, Elsurer C, et al. Is it possible that direct rigid laryngoscope-related ischemia-reperfusion injury occurs in the tongue during suspension laryngoscopy as detected by ultrasonography: a prospective controlled study. Acta Otolaryngol. 2020;140:583-8.

9. Harris VC, Dalesio NM, Clark J, et al. Postoperative Respiratory Complications and disposition in patients with type 1 laryngeal clefts undergoing injection or repair – A Single Institution Experience. Int J Pediatr Otorhinolaryngol. 2020;131:109844.

10. Ekstein M, Zac L, Schvartz R, et al. Respiratory complications after adenotonsillectomy in high-risk children with obstructive sleep apnea: A retrospective cohort study. Acta Anaesthesiol Scand. 2020;64:292-300.

11. Chorney SR, Dailey JF, Zur KB. Pediatric adenoidectomy in the very young child and indications for postoperative inpatient admission. Int J Pediatr Otorhinolaryngol. 2020;130:109796.

12. Tasli H, Birkent H, Karakoc O, et al. The effect of obesity on transnasal flexible laryngoscopy. J Voice. 2019;23:30216-7.

13. Ishman SL, Chang KW, Kennedy AA. Techniques for evaluation and management of tongue-base obstruction in pediatric obstructive sleep apnea. Curr Opin Otolaryngol Head Neck Surg. 2018;26:409-16.

14. Farhood Z, Isley JW, Ong AA, et al. Adenotonsillectomy outcomes in patients with Down syndrome and obstructive sleep apnea. Laryngoscope. 2017;127:1465-70.

15. Thottam PJ, Choi S, Simons JP, et al. Effect of adenotonsillectomy on central and obstructive sleep apnea in children with down syndrome. Otolaryngol Head Neck Surg. 2015;153:644-8.

16. Goldstein NA, Armfield DR, Kingsley LA, et al. Postoperative complications after tonsillectomy and adenoidectomy in children with Down syndrome. Arch Otolaryngol Head Neck Surg. 1998;124:171-6.

17. Walker P, Whitehead B, Rowley M. Role of paediatric intensive care following adenotonsillectomy for severe obstructive sleep apnoea: criteria for elective admission. J Laryngol Otol. 2013;127:26-9.

18. Gehrke T, Scherzad A, Hagen R,et al. Risk factors for children requiring adenotonsillectomy and their impact on postoperative complications: a retrospective analysis of 2000 patients. Anaesthesia. 2019;74:1572-9.

19. Brown KA, Morin I, Hickey C, et al. Urgent adenotonsillectomy: an analysis of risk factors associated with postoperative respiratory morbidity. Anesthesiology. 2003;99:586-95.

20. Chan MT, Chan MS, Mui KS, et al. Massive lingual swelling following palatoplasty. An unusual cause of upper airway obstruction. Anaesthesia. 1995;50:30-4.