Lerner Julia L, Borrelli Mimi R, Jehle Charles C, Benz Elizabeth G, Brown Steven A
Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University.
Division of Dentistry and Oral and Maxillofacial Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
J Craniofac Surg. 2023;34(1):393-397. doi: 10.1097/SCS.0000000000009035. Epub 2022 Oct 3.
While traditionally in the realm of otorhinolaryngology or oral maxillofacial surgery, conditions involving the tongue may also be managed by plastic surgeons. The authors present an unusual case of acquired macroglossia resulting from angiotensin-converting enzyme inhibitor-induced angioedema and review the literature to discuss its surgical management from a plastic surgery perspective. A 62-year-old female suffered severe airway obstruction, respiratory arrest, and anoxic brain injury from angioedema-associated macroglossia. After tracheostomy, the patient was managed nonsurgically, with bite wound care and medications to minimize angioedema to marginal effect. Ultimately, a partial glossectomy was planned. The edematous distal tongue was amputated and closed primarily. On postoperative day 2, she was successfully weaned off mechanical ventilation and no longer suffers trauma from tongue biting. The simple anterior tongue resection described in this paper was an appropriate approach for our patient. More research is needed to guide plastic surgeons in an optimal approach for clinical scenarios.
虽然涉及舌头的病症传统上属于耳鼻喉科或口腔颌面外科的范畴，但整形外科医生也可以对其进行处理。作者介绍了一例由血管紧张素转换酶抑制剂引起的血管性水肿导致获得性巨舌症的罕见病例，并回顾文献，从整形外科的角度讨论其手术治疗方法。一名62岁女性因血管性水肿相关的巨舌症出现严重气道阻塞、呼吸骤停和缺氧性脑损伤。气管切开术后，患者接受了非手术治疗，包括咬伤伤口护理和使用药物以尽量减轻血管性水肿，但效果有限。最终，计划进行部分舌切除术。切除了水肿的舌远端并直接缝合。术后第2天，她成功脱离机械通气，不再遭受咬舌创伤。本文所述的简单前舌切除术对我们的患者来说是一种合适的方法。需要更多的研究来指导整形外科医生针对临床情况采取最佳方法。
