Unusual Case of a Massive Macroglossia Secondary to Myxedema: A Case Report and Literature Review.

Macroglossia is classified as true macroglossia, which exhibits abnormal histology with clinical findings, and relative macroglossia, in which normal histology does not correlate with pathologic enlargement. This report describes an atypical case of morbidity with massive macroglossia secondary to myxedema; the macroglossia enlarged over a 3-month period before being presented to the Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston (Houston, TX). Substantial enlargement of the tongue (16 cm long × 10 cm wide) was first attributed to angioedema, which was refractory to the discontinuation of lisinopril and a C1 esterase inhibitor. A core tongue biopsy examination was performed to rule out angioedema, amyloidosis, myxedema, and idiopathic muscular hypertrophy. Interstitial tissue was positive for Alcian blue and weakly positive for colloidal iron, which are correlated with hypothyroidism and a diagnosis of myxedema. However, the macroglossia did not resolve after correcting for hypothyroidism. The patient required a wedge glossectomy for definitive treatment. She recovered unremarkably, with excellent cosmesis and preservation of lingual and hypoglossal function. There are some case reports of massive macroglossia but none with myxedema as the primary etiology.

The Effect of Deep Vein Thrombosis Prophylaxis on Bleeding in Periorbital Surgery in Trauma Patients.

The aim of this study is to assess if there is an increase in postoperative venous thromboembolism (VTE) or bleeding complications in patients who received perioperative chemical thromboprophylaxis compared with patients in whom chemical thromboprophylaxis was held during periorbital trauma surgery. This is a retrospective chart review of patients undergoing periorbital surgery treated in three different city hospitals, by the Department of Oral and Maxillofacial Surgery, University of Texas, between August 2014 and December 2016. A total of 237 patients were included in this study. None of these patients suffered a postoperative VTE. A total of 102 patients received perioperative pharmacologic thromboprophylaxis in the form of enoxaparin or heparin. In this group, one patient suffered a buccal space hematoma. Chemical thromboprophylaxis was held in 135 patients preoperatively and for at least 24 hours postoperatively. In this group, one patient suffered a retrobulbar hematoma after repair of an orbital floor fracture. The rate of postoperative bleeding complications was compared by the chi-square test and was not statistically significant ( p = 0.8417).