Acute tongue enlargement is a potentially lethal complication which is mostly reported in neurosurgical cases in sitting position. Very rarely it is reported in supine position. Most importantly it is reported at the end of the surgical procedures. Throat pack used along with tracheal intubation for protection of lower respiratory tract from soiling can lead to tongue enlargement due to obstruction of venous drainage. We are hereby reporting an interesting case of acute tongue enlargement in a patient scheduled for excision of brain tumor in supine position which occurred even before commencement of surgery due to excessive throat pack inserted for some nonessential indication. We thus recommend that throat pack should be used cautiously only when absolutely indicated. Otherwise it can lead to life threatening macroglossia.