Ischemic necrosis of the tongue following transoral neurosurgical procedure

Introduction: Postoperative, lingual swelling and necrosis are unusual complications that can lead to life-threatening airway obstruction. We report a case of bilateral ischemic necrosis of the tongue following transoral neurosurgical procedure. Observation: A Davis-Boyle mouth gag was used for tumor exposition and the operation lasted 8 h. At the end of the surgery, we noticed a bluish discoloration with a mild edema of the tongue. The patient had kept intubated in a monitored setting and intravenous steroids were administered. However, the edema increased and necrosis of the tongue appeared 72 h after the surgery. The patient underwent tracheotomy and the necrotic tissue was removed. More than 15 days passed before glossal engorgement resolved. Discussion: The etiology of tongue necrosis is likely related to tissue ischemia, secondary to venous or arterial obstruction. Prolonged use of the Davis-Boyle mouth gag may incur greater risk of ischemic necrosis of the tongue