In spite of its uncommonness, the Hairy Polyp is recognized as a significant pathology that affects both naso and oropharynx. It’s a congenital tumor quite usual for those areas [6
]. However, there are no cases of malignancy reported so far [10
Displaying an approximate incidence of 1 per 40.000 births, most of the cases are considered isolated. According to Burns, Axon and Pahade [1
], the Hairy Polyp is an abnormality of the development, and a common association with such malformation is related to the first and second branchial arches or to the nasopharyngeal membrane. For that reason, it could be linked to systemic alterations, for instance, the Oral-Facial-Digital Syndrome or Dysostosis [11
], being essential a diagnostic investigation.
] regards the term Hairy Polyp
as accurate and explanatory, for the process is considered as a developmental malformation. Its histology, though variable, is typical, and likely to be distinguished from other lesions that may affect the patient, dissociating itself from malign precesses. On the contrary to the epignathus, teratomas and trigeminal teratoids, the Hairy Polyp doesn’t have the endodermal layer in its origin [1
The emergence of this lesion on the tongue frequently happens with children, up to 2 years old. In spite of appearing in different places, the Hairy Polyp is more often seen in the anterior area of the dorsum [11
]. For Carranza [2
], the obstruction of the upper airways can be reckoned as a sign of big lesions. Thus, it must be considered that, the large volume of the lesion reported in this case, besides compromising the vital functions, also hindered the conduction of more conclusive intraoral examinations.
Among possible imaging examination methods, there are ultrasonographies, radiographies and magnetic resonance. The advantage of computed tomography is its fast acquisition time, which facilitates the sedation. In spite of that, the use of ionizing radiation is a factor that must always be kept to a minimum necessary in these patients. The use of iodated oral radiocontrastant, in a reduced amount, dripped on the tongue’s surface, aggregated the advantages of lessening the time of sedation and exposing the area to viewing with a much higher resolution. In addition, it permitted the prompt comprehension of the extension and mobility of the lesion, which used to vary between distal and medial positions, constantly adapting itself to the oral functions.
The subsequently possibility of multiplanar and tridimensional reconstruction adds great academic value to the acknowledgment and comprehension of this pathology and its anatomical associations. In this case, it’s concluded that the whole outline of the process allowed the cylindrical mass, when positioned on the anterior part of the tongue, took on the functions of a pacifier. At a slight swallowing provoked by the contrast used, the lesion made a motion towards the opposite direction. Such a dislodgment, activated upon swallowing, creates favorable conditions for breathing and ingestion difficulties.
It’s possible that suction, when the lesion is moved anteriorly, might have sped up the growth of the lesion, justifying the complaints and the urgency in the intervention. With its body getting more and more voluminous, it was clear that there was a constant mechanical obstruction of the oropharynx.
The stimuli reflexes of coughing and liquid regurgitation, added to difficulties of the reflex between swallowing and breathing, hardened the patient’s feeding and led her into an increased irritability, expressed through crying. The presence of vomiting couldn’t be confirmed. The apprehension of this aspect at the location of the lesion equally guided the choices of orotracheal intubation and general anesthetic.