Ishiyama T, Murakami N, Takeda T, Yamamoto M
Department of Anesthesia, Gifu City Hospital.
Masui. 1990 Apr;39(4):503-7.
A case of macroglossia following neck clipping of VA-PICA aneurysm is described. The etiology of this rare complication has been thought to be venous obstruction related to extreme flexion of the head in the sitting position. On the other hand, Moore et al recently proposed that the primary mechanism of macroglossia after posterior fossa exploration might be neurogenic origin. We consider that our case supports the latter hypothesis. In our case, the lingual swelling was aggravated for four consecutive days following the operation and then began to improve rapidly. The swelling resolved completely after 4 weeks. Glyceol and methylprednisolone sodium succinate were administered in an attempt to decrease the lingual swelling. But these drugs did not effectively minimize the swelling. It seemed that the lingual swelling resolved spontaneously. If macroglossia following posterior fossa exploration can be caused by abnormal autonomic nervous system discharges, stellate ganglion block, glossopharyngeal nerve block or vagus nerve block is thought to be indicated as treatment for the lingual swelling.
本文描述了1例椎动脉-小脑后下动脉（VA-PICA）动脉瘤夹闭术后出现巨舌症的病例。这种罕见并发症的病因被认为与坐位时头部极度屈曲导致的静脉阻塞有关。另一方面，Moore等人最近提出，后颅窝探查术后巨舌症的主要机制可能是神经源性的。我们认为我们的病例支持后一种假设。在我们的病例中，术后舌部肿胀连续4天加重，然后开始迅速改善。4周后肿胀完全消退。给予甘油和琥珀酸钠甲泼尼龙以减轻舌部肿胀。但这些药物并未有效减轻肿胀。舌部肿胀似乎是自行消退的。如果后颅窝探查术后的巨舌症是由自主神经系统异常放电引起的，那么星状神经节阻滞、舌咽神经阻滞或迷走神经阻滞被认为是治疗舌部肿胀的方法。
