Difficult endotracheal intubation secondary to tracheal deviation and stenosis in a patient with severe kyphoscoliosis: a case report

Abstract

We report on a case of difficult endotracheal intubation in a patient with marked tracheal deviation at an angle of 90 degrees combined with stenosis due to kyphoscoliosis with vertebral body fusion. After induction of general anesthesia, a proper laryngeal view was easily obtained using a videolaryngoscope. But a tracheal tube could not be advanced more than 3 cm beyond the vocal cords due to resistance, despite various attempts, including the use of small size tubes, full rotation of the tube tip, and fiberoptic bronchoscopy. Ultimately, the airway was successfully secured by placing a tube tip above the area of resistance and by additionally packing saline-soaked gauzes around the tracheal inlet to minimize gas leakage and to fasten the tube in the trachea.

Secondary tracheal distortion in an adult patient after therapy for diphtheria at childhood

“…The most common symptoms evident in patients with tracheal stenosis are: wheezing, breathing difficulties, stridor, and in general respiratory distress 7 . However, the tracheal stenosis may not be evident by the occurrence of particular symptoms, like in our case, where the patient did not manifest any symptoms.…”

A novel case of tracheal deviation secondary to percutaneous tracheostomy

“…Cases of concurrent airway stenosis and tracheal deviation include compression of the airways from nearby cancer or thyroid goitre. One case describes a patient with a 90° tracheal deviation at the level of severe spinal kyphoscoliosis [ 9 , 11 , 13 ]. Tracheal stenosis was distal to the site of deviation in these cases and did not cause significant respiratory symptoms, and the stenosis was ultimately reversed with treatment of underlying cause.…”

Anesthetic management of a child with Kagami-Ogata syndrome complicated with marked tracheal deviation: a case report

“…However, it is unclear whether this tracheal deviation is specific to patients with KOS, because there are no previous reports of tracheal deviation in patients with KOS. The tracheal deviation could be caused by various factors, including a thyroid goiter, a tumor in the neck and thorax, trauma, lung collapse, or spinal deformities [9]. Whatever the cause may be, in most previous reports, the authors tried to advance the tracheal tube below the deviated area and were usually successful [9].…”

“…The tracheal deviation could be caused by various factors, including a thyroid goiter, a tumor in the neck and thorax, trauma, lung collapse, or spinal deformities [9]. Whatever the cause may be, in most previous reports, the authors tried to advance the tracheal tube below the deviated area and were usually successful [9]. However, there are a few reports of failure to intubate below the deviated area.…”