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Giant Macroglossia in Head and Neck Cancer Survivor: The Unsolved Issue

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Introduction: Most laryngeal cancers are squamous cell carcinomas. These tumors are often diagnosed in males over the age of 50, heavy smokers and drinkers. Thanks to the recent advances in multidisciplinary treatment overall survival has increased and thus the number of long-term survivors. Macroglossia may be secondary to head and neck cancer treatments occurring due to a blockage of the efferent lymphatic vessels and it is incurable. It seems to be an indolent complication, however, it can cause serious feeding difficulties, bleeding or ulcerations and subsequently infections with a reduction in quality of life and even survival. Case Report: A 72-year-old man heavy smoker was diagnosed with undifferentiated laryngeal squamous cell carcinoma stage III (T2N2bMo). He underwent an oncological surgery followed by concurrent chemoradiation therapy. Thirteen months after the patient complained about a slowly progressive tongue swelling with eating and speaking difficulties and sialorrhea. An otolaryngological exploration did not show any lesion but a tongue thickening with a massive enlargement was noticed. He was treated with diuretics, steroids and cervical massages with a slight objective improvement. The patient's general condition deteriorated quickly due to a respiratory infection causing his death. Conclusion: Macroglossia secondary to lymphedema in patients with head and neck cancer warrants an intensified search for new treatment approaches, especially since survival of these patients has improved markedly. Complications secondary to this condition can be very relevant and sometimes can cause the patient's death.

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