Acquired laryngomalacia as a cause of post-extubation respiratory failure in patient with postoperative seizure and central pontine myelinolysis after craniotomy

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  • Akimoto Yusuke
    Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
  • Bando Natsuki
    Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
  • Sato Hiroki
    Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
  • Sato Koji
    Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
  • Momota Kazuki
    Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
  • Nunomura Toshiyuki
    Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan
  • Ueno Yoshitoyo
    Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
  • Ishihara Manabu
    Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
  • Tane Natsuki
    Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
  • Itagaki Taiga
    Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan
  • Oto Jun
    Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan

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<p>Background : Laryngomalacia is a congenital abnormality of the larynx that commonly occurs in children and rarely in adults. We report the first case of acquired laryngomalacia mainly due to postoperative seizure and central pontine myelinolysis after scheduled craniotomy. Case presentation : A 69-year-old man was admitted to the hospital for elective craniotomy for craniopharyngioma. After the surgery, he developed refractory seizure and required intubation and mechanical ventilation in the intensive-care unit (ICU). After treatment for the seizure, he was extubated. However, immediately after extubation, he developed stridor and respiratory retraction. We performed fiberoptic laryngoscopy and confirmed that the epiglottis had collapsed into the posterior wall of the pharynx during inspiration, which was suspected to be laryngomalacia. He received invasive mechanical ventilation for two days following re-extubation. After the second extubation, he developed stridor again due to acquired laryngomalacia. Six days later, his respiratory condition had worsened, and he received re-intubation and tracheostomy. After ICU discharge, central pontine myelinolysis was diagnosed by magnetic resonance imaging. Conclusions : Adult-onset laryngomalacia is a rare cause of upper airway obstruction but should be considered as a cause of postoperative extubation failure. We should not delay performing fiberoptic laryngoscopy to evaluate this pathology and provide optimal treatment. J. Med. Invest. 69 : 316-319, August, 2022</p>

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