[Perioperative management for partial resection of a lymphangioma of the tongue].

Twelve month old boy had been suffering from a neck lymphangioma. Partial resection was carried out in his newborn period at another hospital, and he was obliged to be tracheostomied because of severe airway obstruction due to postoperative edema. He was scheduled for partial glossectomy since his tongue had increased in mass, which could easily be injured by teeth, and he had difficulties in swallowing recently. His airway was not obstructive even during sleep and preoperative MRI showed adequate space around the larynx. We induced anesthesia by a mask and he was subseqently intubated with a fiberscope via his nose because his huge and less mobile tongue could not allow the insertion of a laryngoscope and this might cause bleeding. We did not extubate the endotracheal tube for fear of airway obstruction attributable to postoperative edema. Marked edema around the neck persisted longer than we expected. We tried to evaluate the degree of diminution of edema with MRI twice to decide when extubation could be attempted. However, examination with MRI could not give us useful informations. Consequently we evaluated the timing of extubation by examining whether he could close his mouth or not, whether his tongue could move freely and the degree of edema. We realized lymphangioma caused marked and extensive edema after the operation and we should keep in mind that lymphangioma of the tongue might cause various anesthetic problems especially on airways.