A 12-year-old boy (height, 123 cm ; weight, 20 kg) with a history of cerebral palsy, West syndrome, and severe intellectual disability was brought to our hospital for evaluation of gingival hypertrophy and snoring.
The patient’s condition was diagnosed as drug-induced gingival hyperplasia, and surgery was planned. He had previously undergone general anesthesia and had consulted an anesthesiologist at another hospital. We subsequently requested an otolaryngology evaluation to assess the patient’s airway. Fibreoptic bronchoscopy was prepared as a precaution, but video laryngoscopy was used for intubation. After confirming the absence of bleeding from the surgical field or laryngeal edema, the patient was extubated and transferred to the ICU. On the second postoperative day, the patient exhibited labored breathing due to swelling in the submandibular region. Accordingly, we again requested an otolaryngology evaluation to assess airway edema. A nasal airway was inserted because the airway around the soft palate had narrowed owing to postoperative pharyngeal edema. It was removed on the fifth postoperative day, and the patient was discharged on the sixth postoperative day. The patient’s physician was requested to reduce the phenobarbital dosage, which was identified as a possible cause.
Drug-induced gingival hyperplasia can develop rapidly, leading to sleep-related breathing disorders. If severe, it may cause difficulty in securing the airway or postoperative airway stenosis due to surgical stress. Careful airway management is, therefore, essential during the perioperative period.
