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General Rehabilitation

Severe Macroglossia Following Decompressive Craniotomy: A Multidisciplinary Approach to Management and Functional Recovery

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 1

    Poster Presenter(s)

  • Trushti Patel, DO (she/her/hers)

    Resident Physician
    Albert Einstein Healthcare Network/MossRehab PM&R Program
    Elkins Park, Pennsylvania

    • Co-Author(s)

  • EB

    Emily Baas, MD (she/her/hers)

    Resident
    Albert Einstein Healthcare Network/MossRehab PM&R Program
    Philadelphia, Pennsylvania

  • David Hopkins, MD

    Resident Physician
    Albert Einstein Healthcare Network/MossRehab PM&R Program
    Philadelphia, Pennsylvania

  • JB

    Jaclyn Barcikowski, DO

    Clinical Director Stroke Rehab Program
    Albert Einstein Healthcare Network/MossRehab PM&R Program
    Jenkintown, Pennsylvania

Disclosure(s):
Trushti Patel, DO: No financial relationships to disclose
Emily Baas, MD: No financial relationships to disclose
David Hopkins, MD: No financial relationships to disclose
Jaclyn Barcikowski, DO: No financial relationships to disclose
Case Diagnosis: Severe macroglossia

Case Description or Program Description: A 40-year-old female with a left middle cerebral artery ischemic infarct complicated by hemorrhagic conversion underwent a decompressive craniotomy with partial frontal lobectomy. Post-operatively, she developed severe macroglossia, likely due to lymphedema from prolonged surgery and positioning. The macroglossia pronounced that it obstructed her airway, preventing her from closing her mouth and resulting in significant tongue sensitivity. Additionally, the tongue showed indentations from her teeth, raising concern for potential necrosis. As a result, she required a tracheostomy for airway management.

The patient was transferred to inpatient rehabilitation, where she received a comprehensive, multidisciplinary approach to manage the macroglossia-induced lymphedema. The rehabilitation treatment included osteopathic manipulative treatment, lymphedema-focused physical therapy, daily tongue wrapping

Setting: Acute inpatient rehabilitation

Assessment/Results: The patient was evaluated by ENT, undergoing manual reduction followed by maxillomandibular fixation and partial glossectomy. Her tracheostomy was eventually decannulated. On admission, the patient was dependent for activities of daily living and mobility. By discharge, she progressed to supervision to moderate assistance. Upon discharge, she demonstrated verbal output, though minimal.

Discussion (relevance): Macroglossia is a rare but potentially serious complication following neurosurgical procedures, resulting from upper airway edema. Timely and comprehensive management is critical, as it can significantly reduce the need for a glossectomy or, at the very least, minimize the extent of surgical intervention required. Resolution of macroglossia significantly improved the patient’s functional independence.

Conclusions: This case underscores the importance of a multidisciplinary and targeted rehabilitation approach in managing severe macroglossia following neurosurgery. The integration of lymphedema-specific therapies and osteopathic manipulative treatment proved beneficial in promoting recovery and improving functional outcomes.