Airway challenges posed by tongue injuries following neurosurgical procedures in prone position

Abstract

Safe patient position is an important aspect of anaesthesia care. Prone position during neurosurgery may be associated with airway oedema or complications such as tongue injuries or swelling. Prevention of such morbidities with proper planning, meticulous positioning, continuous vigilance, early diagnosis and aggressive treatment are crucial. We describe the perioperative events of three patients who presented with tongue-related morbidity following neurosurgical procedures in the prone position where one developed tongue haematoma and other two had macroglossia in the postoperative period. The patient with haematoma was asymptomatic and required no intervention apart from reassurance about the self-resolving nature of haematoma. Two patients with macroglossia were kept intubated, nursed in head-up position and administered intravenous steroids and local antidesiccants. One patient required tracheostomy while the other could be extubated 48 h postoperatively. Vigilance, prompt diagnosis and appropriate management improved overall outcome.