J Rhinol.  2016 May;23(1):60-64. 10.18787/jr.2016.23.1.60.

A Case of Huge Lingual Tonsillar Hypertrophy Causing Obstructive Sleep Apnea in Adult

• Han HJ
• Lee DJ
• Mo JH
• Lee SJ

• KMID: 2165157
• DOI: http://doi.org/10.18787/jr.2016.23.1.60

Abstract

Obstructive sleep apnea is characterized by repeated episodes of obstructive apnea and hypopnea. Lingual tonsillar hypertrophy causing obstructive symptoms is a rare disease in adults. Recently, we experienced a case of obstructive sleep apnea due to massive lingual tonsillar hypertrophy. The patient had tonsillectomy as a child and underwent adenoidectomy three years prior to the current presentation due to snoring and sleep apnea. However, symptoms did not improve and were recently aggravated. The upper airway evaluation and polysomnography revealed excessive lingual tonsillar hypertrophy and severe obstructive sleep apnea. An enlarged lingual tonsil was successfully removed using a Coblator. No recurrence was observed, and the obstructive sleep apnea was resolved postoperatively.

Keyword

Tonsil; Hypertrophy; Lingual; Obstructive sleep apnea

MeSH Terms

Adenoidectomy
Adult*
Apnea
Child
Humans
Hypertrophy*
Palatine Tonsil
Polysomnography
Rare Diseases
Recurrence
Sleep Apnea Syndromes
Sleep Apnea, Obstructive*
Snoring
Tonsillectomy

Figure

• 

  Fig. 1. Preoperative endoscopic findings. Nasopharyngeal airway was patent with mild tubal tonsillar hypertrophy around eustachian tube orifice (A). Enlarged lingual tonsil on tongue base was observed and the larynx could not be seen because of large lingual tonsil (B).

• 

  Fig. 2. Preoperative contrast-en-hanced CT showed the hypertrophy of lingual tonsil (LT) which markedly obstructed the airway. Axial (A) and sagittal view (B).

• 

  Fig. 3. Pathologic findings. On microscopic view, reactive follicles with normal lymphoid tissue were identified (H&E, ×25) (A). The reactive lymphoid tissue showed excessive increase of the germinal center (H&E, ×50) (B).

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  Fig. 4. Endoscopic findings (A) and cephalometric lateral radiograph (B) at 5 months after operation. The endoscopic findings showed reduced lingual tonsil and the normal laryngeal column. The cephalometric lateral radiograph showed that the airway is patent.

Reference

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