# Glossoptosis After Tracheal Extubation in a Patient With Oculopharyngeal Muscular Dystrophy: A Case Report

## TL;DR

A patient with oculopharyngeal muscular dystrophy developed glossoptosis after surgery, highlighting risks in airway management for such patients.

## Contribution

Highlights the risk of glossoptosis in oculopharyngeal muscular dystrophy patients post-extubation, even without prior pharyngeal symptoms.

## Key findings

- Glossoptosis and hypoxia occurred after extubation in a patient with oculopharyngeal muscular dystrophy.
- Normal train-of-four ratio did not ensure safe extubation in this case.
- Current guidelines lack specific recommendations for managing such patients.

## Abstract

Oculopharyngeal muscular dystrophy is a late-onset genetic disorder that causes progressive weakness of the eyelid and pharyngeal muscles. Herein, we report a case of oculopharyngeal muscular dystrophy and glossoptosis following extubation.

A 53-year-old Japanese woman with oculopharyngeal muscular dystrophy was scheduled to undergo surgery for ptosis. Although dysphagia was not observed, she experienced mild limb numbness. Total intravenous anesthesia was administered, followed by intravenous rocuronium (0.5 mg/kg), and tracheal intubation was performed. The train-of-four ratio exceeded 1 before surgery was completed. After surgery, the patient was awakened and extubated. However, glossoptosis and hypoxia developed, necessitating sugammadex administration.

In oculopharyngeal muscular dystrophy, even patients without apparent pharyngeal or laryngeal symptoms may have impaired upper airway muscle function. Complete recovery of the adductor pollicis train-of-four ratio does not necessarily ensure safe extubation. Since current guidelines provide no recommendations for such cases, further discussion and the development of management strategies, including the consideration of routine reversal, are warranted.