Lingual artery aneurysm as a rare complication of tonsillectomy; a case report

Tonsillectomy is the most commonly performed operation in the field of Otorhinolaryngology. The most important complications of tonsillectomy include bleeding, damage to the surrounding structures, aspiration of blood, infection, and lungedema or abscess. We report a case of lingual artery aneurysm as a rare complication of tonsillectomy.Case Report: The patient is a 6 years old boy who presented to Taleghani Hospital Out-Patient Department, Tehran, with a painful swelling of the left neck and jaw since one month. There was a history of tonsillectomy 40 days back (10 days before the swelling began). On examination, we found a 6 times 6 cm mass involving the left submandibular area with some extension into the mandible. The patient was diagnosed provisionally as deep neck infection and was put on broad-spectrum antibiotics. Emergency angiography of the carotid artery and its branches showed no abnormalities. The mass, finally, was aspirated using a No.25 needle, and blood was collected. The patient was shifted to the operating theatre and the pseudoaneurysm of the lingual artery was confirmed. Pseudoaneurysm of the lingual artery is a very rare complication of tonsillectomy, and is secondary to intra-operative trauma or post-operative infection. Lingual artery aneurysm usually presents with a painful neck swelling, massive bleeding from the tonsil bed or a unilateral palatine mass. It can be easily mistaken with a peritonsillar or parapharyngeal abscess. It is sometimes difficult to diagnose it using angiography, the reason of which is the course of the lingual artery as well as its anatomical loop around the superior constrictor muscle. Early diagnosis is of utmost importance in the management of the lingual artery pseudoaneurysm.