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Can Tonsillar Retractor–Induced Tongue Edema Be a New Complication in Pediatric Patients Undergoing Tonsillectomy Detected by Ultrasonography? A Prospective, Case-Controlled, Observational Study

September 28, 2022

Background: Tonsillectomy is one of the most common surgical procedures in pediatric patients. The tonsillar retractor, which is routinely used during a tonsillectomy, applies high pressure to the patient’s tongue and can lead to various complications.
Aims:
This study aimed to explore tongue edema induced by the pressure applied by tonsillar retractor, using ultrasonography in pediatric patients undergoing tonsillectomy surgeries.
Materials and Methods:
Sixty-one patients were included in the study. The tonsillectomy group included 31 patients who underwent tonsillectomy surgery, while the control group included 30 patients who underwent inguinal hernia and circumcision surgery. Submental coronal plane ultrasonography examinations of the tongue were performed twice for each patient. In the tonsillectomy group, the first examination of tongue area (TA 1 ) was done immediately after intubation but before the placement of tonsillar retractor. The second examination (TA 2 ) was done at the end of the tonsillectomy surgery after the removal of the tonsillar retractor but before extubation. In the control group, the first examination (TA 1 ) was done immediately after intubation, whereas the second examination (TA 2 ) was done at the end of the surgery before extubation. These results were compared with those for the control group.
Results:
Groups were similar in terms of demographics and intubation duration. Groups did not significantly differ in terms of TA1 (P ¼ .212), but they significantly differed in terms of TA 2 (P ¼ .000). They also significantly differed in terms of tongue edema defined as TA2 � TA1 (P ¼ .000).
Conclusions and Significance:
Tonsillar retractor does cause tongue edema in tonsillectomy surgeries. This tongue edema seems to be a result of the pressure applied by the tonsillar retractor. This study is the first to demonstrate the possible role of ultrasonography examination in determining the tonsillar retractor–induced tongue edema in pediatric patients
Keywords
tonsillectomy, complications, enlarged tongue, children, ultrasonography, diagnostic imaging