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Mandibulectomy most commonly performed as surgical management of oropharyngeal carcinoma leads to a wide array of anatomical and physiological changes which result in an anticipated difficult airway. There may be posterosuperior displacement of hyoid bone and tongue leading to reduction of retropalatal space along with loss of structural support to the tongue predisposing it to prolapse and development of obstructive sleep apnoea. Bulky flap reconstruction, limited mouth opening, and radiotherapy limiting neck mobility further compound the difficulty in airway management. This leads to a wide spectrum of issues ranging from difficulty in face mask ventilation to laryngoscopy and intubation. It is essential to individualize each case with a preformulated strategy outlining the primary and alternative approaches. A literature search was carried out using search engines like PubMed, Embase, Medline, and Google scholar using the terms “Difficult airway”, “Post-mandibulectomy”, “Difficult laryngoscopy, and Intubation”. The available literature was thoroughly reviewed by the authors before the final drafting of this article. A multidisciplinary team approach, thorough assessment, meticulous preparation, and critical decision-making are essential for successfully managing a difficult airway post-mandibulectomy.

We read with interest the article titled, 'Management of retropharyngeal node metastases from thyroid carcinoma' by Hartl et al. [1]. We congratulate the authors on addressing the issue of Retropharyngeal lymph node metastasis in thyroid cancer in the era of PET scan, with the advent of which there has been an increase in the incidence of detection of recurrences and also there is an increasing dilemma for the knife happy Endocrine surgeon as to whether wait and watch or to intervene. We agree with the authors that these retropharyngeal nodes are difficult to visualize on routine ultrasonography, difficult to dissect, and difficult to decide on intervention. We also appreciate the art of combining original case series with review of literature which is apt for rare cases like Retropharyngeal Node Metastases in thyroid cancer. We have few queries which may be of interest for the future readers.We would like to know the location of the tumor in relation to the thyroid lobe such as upper one-third, middle one-third, or lower one-third [2]. Did the authors record this finding? We would also like to know the side of the primary tumor and the retropharyngeal node in relation to the primary tumor such as ipsilateral or contralateral metastases. We would also like to know the average number of retropharyngeal nodes dissected by authors in each case [3] and also whether any non malignant node was found enlarged in the retropharyngeal space? References 1. Hartl DM, Leboulleux S, Vélayoudom-Céphise FL, Mirghani H, Déandréis D, Schlumberger M (2015) Management of retropharyngeal node metastases from thyroid carcinoma. World J Surg 39(5):

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