Soofia Ahmed, Atif Saeed, Jamshed Akhtar, Aqil Soomro, Dharam Pal.
Macroglossia secondary to Lymphangioma.
J Surg Pak Jan ;7(2):41-3.

Lymphangioma is not an uncommon condition in paediatric age group but tongue as its primary location leading to macroglossia is a rare lesion. In this case report we describe our experience of macroglossia secondary to lymphangioma of tongue involving its anterior 2/3rd in a three year old child. Wedge resection of involved part was done. Post operative course was uneventful. The child is on regular follow up.

CASE REPORT: A Three years old male child presented with enlarged tongue which was noticed at birth. Since then it has gradually increased in size. Patient can take liquid diet but it is not possible for him to chew and masticate because of macroglossia. There was continuous drooling of saliva with foul odour. Patient was unable to comprehend and was in a miserable condition. Clinically child was anemic with hemoglobin of 7.5 gm%. Tongue was found diffusely ,enlarged in its anterior part. Clinically diagnosis of lymphangioma of tongue was made. Blood transfusion was given. Oral hygiene was advised. Child was operated electively. Endotracheal intubation was difficult because of difficulty in visualizing laryngo-pharynx. The tongue was forcibly pulled out of mouth to introduce laryngoscope. ETT was then passed through nasotracheal route. Throat was packed with roll gauze. On closed examination of tongue under GA, it was found that the lesion was limited to anterior 2/3rd of the tongue. Tongue was grasped at its tip and pulled out of mouth so that posterior part could be examined easily. Two lateral stay sutures were applied through full thickness of tongue from its middle on each side. A wedge resection of anterior 2/3rd of tongue was performed removing almost whole of the lesion. The residual tongue was approximated in midline with polyglycolic sutures. After confirming haemostasis throat pack was removed. Post operative recovery was uneventful. Patient did not experience any difficulty in breathing. Mouth wash outs were started from next morning. Liquid diet was allowed orally after 48 hours and patient was discharged home on 3rd post operative day. Biopsy report was that of lymhangioma infiltrating whole of the resected specimen. In follow up period child looked comfortable but as protrusion of lower jaw was present he was unable to close his mouth properly. Tongue was mobile and he also stared eating solid food. He was advised to see orthodontic specialist and speech therapist so that further management with regards to open bite and speech could be planned. He was also advised to come for follow up every 6 months to detect any recurrence of original pathology.

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