Severe postoperative laryngeal oedema causing total airway obstruction immediately on extubation

We report a case of total upper airway obstruction occurring immediately af ter extubation after elective bi-maxillary osteotomy. The obstruction was c aused by severe, progressive supraglottic oedema, which totally obscured th e laryngeal inlet. No swelling had been present at initial laryngoscopy and intubation. Immediate re-intubation of the patient's trachea was difficult but life saving. Subsequent investigations revealed extensive soft tissue swelling, maximal at the level of the hyoid and extending downwards into th e trachea. The cause of such severe oedema in this case is not certain, but may be related to vigorous submental liposuction carried out at the end of operation. We have found no other reports of total airway obstruction occu rring immediately after extubation as a result of this cause. We review the appropriate literature, describe the postoperative management and suggest precautions in similar patients.