Delayed Airway Obstruction after Craniotomy in the Park-Bench Position: Two Case Reports

Abstract

Tomoki Yamaguchi1, Shigehiko Uchino, Shogo Kaku, Akihiko Teshigawara, Kengo Nishimura, Masanori Takinami,Yuichi Murayama and Shoichi Uezono

The park-bench position is used for patients requiring posterior fossa procedures. Manipulation of the head and neck during positioning can have serious consequences, such as quadriplegia, cerebral infarction, or brachial plexus injury. However, delayed airway obstruction related to the park-bench position has been rarely reported in the medical literature. We report two cases in which the patients experienced delayed unilateral massive swelling of the neck and face after craniotomy in the park-bench position. One of the two patients required emergency endotracheal intubation and subsequent tracheotomy. We performed a literature search and found only seven reported cases in the English literature, including our two cases. All cases were reported from Asian countries; India, Japan and Taiwan. Four reports included patient height and weight, with body mass index ≤ 19.2kg/m2 . To gain optimal surgical access to the posterior fossa, the neck of some patients might be excessively flexed laterally, especially if they are underweight. We warn that hyperflexion of the neck in the park-bench position might cause delayed airway swelling, especially for patients who are underweight.

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