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Case Reports
. 2022 Nov 21;14(11):e31759.
doi: 10.7759/cureus.31759. eCollection 2022 Nov.

Massive Congestive Facial and Submandibular Oedema Due to Extreme Neck Flexion Following Suboccipital Craniectomy: A Case Report

Balaji Vaithialingam  1 , Dheeraj Masapu  1 , Satish Rudrappa  2
Affiliations
Case Reports

Massive Congestive Facial and Submandibular Oedema Due to Extreme Neck Flexion Following Suboccipital Craniectomy: A Case Report

Balaji Vaithialingam et al. Cureus. .

Abstract

A variety of factors could contribute to facial oedema during a prone neurosurgical procedure. For optimal surgical exposure, suboccipital cranial surgeries frequently necessitate extreme neck flexion. Extreme neck flexion in the prone position can impair venous drainage of the facial and oropharyngeal structures, leading to life-threatening oedema, so a two-fingerbreadth space between the chin and the sternum is critical. We present a case of massive facial oedema with submandibular swelling in a patient who underwent foramen magnum decompression in the prone position for Arnold Chiari malformation.

Keywords: arnold chiari malformation; congestive oedema; neck flexion; submandibular swelling; suboccipital craniectomy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. T2-weighted MRI (sagittal) showing cerebellar tonsil herniation through the foramen magnum with an intramedullary syrinx
Figure 2
Figure 2. Patient in the prone position with the head fixed on the pin holder with extreme neck flexion for foramen magnum decompression
Figure 3
Figure 3. Facial and submandibular oedema with tongue and lip swelling in the immediate postoperative period.
Figure 4
Figure 4. Resolution of oedema on the fifth postoperative day.
See this image and copyright information in PMC

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