Surgical goals are to reduce the tongue size and produce improved function. Good airway management is important in the postoperative period. For small children and infants this may be done with tracheotomy, and in older children prolonged intubation may be adequate. Different authors have advocated a number of different approaches for tongue reduction. Rather than using one approach, each case should be evaluated and the appropriate surgical approach chosen.
Different resections provide reduction in different directions.
Regardless of the approach taken the initial resection should be conservative to prevent permanent problems from overly aggressive resection. The technique used is an anterior wedge resection with posterior key hole. The lateral incisions are beveled out to decrease tongue bulk. The tongue is then closed in a T. Surgical results have been good. In a series of nine patients with macroglossia, Siddiqui and Pensler reported good results.