Abstract
Hair tourniquet syndrome (HTS) is a condition, where a strand of hair encircles the base of an appendage. We report a rare case of HTS of the uvula and review relevant literature.
KEYWORDS: Amputation, appendage, hair tourniquet syndrome, uvula
INTRODUCTION
Hair tourniquet syndrome (HTS) occurs when a strand of hair encircles the base of an appendage. In some cases, a formidable knot forms and the resulting tightened noose slowly strangulates the appendage.[1] Here, we report a rare case of HTS of the uvula and review relevant literature.
CASE REPORT
A 7-month-old girl presented to the emergency room with complaints of a strand of hair stuck in the mouth [Figure 1]. Attempts at removal by the parents were unsuccessful. There were no episodes of gagging, coughing, or any breathing difficulty. On examination, a single strand of hair was seen coming from the mouth. On oral examination, the hair strand was seen encircling an edematous uvula. As the child was very irritable, no attempt was made to remove the hair tourniquet in the emergency room. The child was shifted to the operation theater, and under general anesthesia, the knotted strand of hair was cut and removed [Figure 2]. After the removal of the hair tourniquet, the uvula became pink and the edema decreased considerably. The baby was observed overnight and discharged the following day on full feeds.
Figure 1.
Child presenting with hair strand stuck in the mouth
Figure 2.
Hair strand knotted around an edematous uvula
DISCUSSION
HTS is the strangulation of fingers, toes, penis, or uvula caused by wrapping of hair at the base. It usually occurs in infants from 2 to 6 months of age. It corresponds to the maternal postpartum hair loss called as telogen effluvium.[2] The mechanism of injury is postulated to be impedance of lymphatic drainage of the appendage by the constricting hair or thread. This initiates a cascade of events starting with lymphoedema followed by venous outflow obstruction. Eventual arterial inflow obstruction leads to ischemia and autoamputation in severe cases.[3,4,5] The exact etiology is unknown. It is postulated that hair becomes entangled when it is wet and pliable. As it dries, it constricts leading to a tourniquet effect.
Only three cases of hair tourniquet of the uvula have been reported in the English literature. Their age of presentation, treatment, and outcomes are summarized in Table 1.
Table 1.
Management and outcome of the three reported cases of hair tourniquet of the uvula
| Authors | Year | Age (months) | Intervention | Result |
|---|---|---|---|---|
| McNeal RM (7) | 1987 | 13 | Conservative | Auto- amputation of uvula |
| Krishna S, Paul RI (4) | 2004 | 3 | Removal in OT | Recovery |
| Flores JR (5) | 2014 | 24 | Removal in OT | Recovery |
Often, children present with inconsolable crying and irritability with no obvious cause. In such cases, a careful examination of all fingers and toes along with the external genitalia and a thorough examination of the oropharynx is a must. Often, the child is distressed enough to make an examination difficult.
Management has been diverse and imaginative. Depilatory creams have been used for hair tourniquets as they are painless and noninvasive. However, they can be used in only early cases with no skin ulcerations and in areas away from mucous membranes.[6] Many cases need surgical release of the tourniquet under anesthesia. These children are often very young. This approach facilitates a thorough examination and gentle removal of the tourniquet and evaluation of the deeper extension and injury to tissues.
Prompt diagnosis and treatment are essential as delay in treatment can lead to tissue ischemia, partial necrosis, and finally autoamputations.[7]
CONCLUSION
The awareness of HTS is essential for early diagnosis and treatment and avoidance of complications inherent in a delayed diagnosis. Examination under anesthesia and complete removal of the hair under vision is the safe and effective way to manage these cases.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
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