Aspiration as the first-choice procedure for airway management in an infant with large epiglottic cysts: A case report

Abstract

BACKGROUND Epiglottic cysts is a rare but potentially lethal supraglottic airway pathology in infants due to the high risk of cannot intubation or cannot ventilation. Awake fiberoptic intubation appeared to be the safest technique, but it is very challenging in infants with large epiglottic cysts. Even it has the risk of airway loss. We report that cyst aspiration is an effective treatment as the first-choice procedure for airway management in an infant with large epiglottic cysts. CASE SUMMARY A 46-day-old male infant weighing 2.3 kg presented to the emergency room with difficulty feeding, worsening stridor, and progressive respiratory distress. Epiglottic cysts was diagnosed, but fibro bronchoscopy examination failed, as the fiberoptic bronchoscope was unable to cross the epiglottic cysts to the trachea. The infant was transferred to the operating room for emergency cystectomy under general anesthesia. Spontaneous respiration was maintained during anesthesia induction, and cyst aspiration was performed as the first procedure for airway management under video laryngoscopy considering that the preoperative fibro bronchoscopy examination failed. Then, the endotracheal tube was intubated successfully. Cystectomy was performed uneventfully, and the infant was safely transferred to the intensive care unit after surgery. The infant was extubated smoothly on the third postoperative day and discharged on the eighth day after surgery. On follow-up 1 year after the surgery, a normal airway was found by fibro bronchoscopy examination. CONCLUSION Epiglottic cyst aspiration can be considered the first procedure for airway management in infants with large epiglottic cysts.

Difficult endotracheal intubation due to a large epiglottic cyst: A case report

“…Therefore, the anesthetic treatment of patients with epiglottic cysts has great specificities. [3] In patients with a clear preoperative diagnosis, those with a small cyst, and those who have no obvious symptoms, conventional anesthesia induction can be used. Short-term muscle relaxants, such as succinylcholine, can be used.…”

“…Therefore, the anesthetic treatment of patients with epiglottic cysts has great specificities. [ 3 ]…”

“…An epiglottic cyst is a type of benign tumor that is formed due to the obstruction of the mucinous duct and the retention of glandular secretion; it is usually found in the lingual plane of the epiglottis and can occur in patients of all ages. [1][2][3] Adult epiglottic cysts can be asymptomatic or show mild symptoms. With the growth of the tumor, patients can feel foreign body sensation, pharyngeal pain, a sense of obstruction, and even dyspnea; however, airway obstruction is a rare symptom.…”

Epiglottic Epidermoid Cyst: Cadaveric Case Report and Clinical-Surgical Applications

“…The authors recommend that a video laryngoscope is effective for assistance in an unexpectedly difficult airway with issues with ventilation and intubation. For their part, Zheng et al [ 10 ] in a 46-day-old male infant with a large epiglottic cyst, recommends aspiration as the first-choice procedure for airway management, however, it is very important to consider the risk of infection and pulmonary aspiration associated with this intervention.…”