Difficult fiber-optic intubation in a patient with giant neck masses: The role of McCoy laryngoscope in elevating compressed laryngeal aperture

Abstract

Airway management in patients with giant neck masses is usually a challenge to anesthesiologists. A giant neck mass could compress the airway and thus impede endotracheal intubation. We encountered a situation where the giant neck masses of a patient pushed the epiglottis posteriorly toward the posterior pharyngeal wall and compressed the laryngeal aperture narrowing after anesthetic induction, causing direct laryngoscopic intubation and sequential fiber-optic intubation failed. The neck masses twisted the aryepiglottic fold tortuously and clogged the laryngeal aperture tightly, making a flexible fiber-optic bronchoscope unable to pass through the laryngeal aperture. Later, we utilized a McCoy laryngoscope alternately to lift the compressed larynx up and away from the posterior pharyngeal wall, creating a passage and completing endotracheal intubation successfully with the aid of a gum elastic bougie. Our case suggested that the tilting tip blade of the McCoy laryngoscope could lever the tongue base up against the tumor mass compression to improve laryngeal views and facilitate endotracheal intubation when a difficult fiber-optic intubation was encountered on a compressed laryngeal aperture.

Anaesthetic Management of Huge Thyroid Swelling by Using I - Lma

“…1 However, fiber-optic intubation may become extremely difficult in the situation of a distorted airway, or when fiberscopic views are obscured, by e.g., massive hematemesis or plentiful sputum. 4 We here present a case of huge thyroid in whom fibreoptic intubation failed and tracheal intubation was done using Intubating LMA.…”

Anaesthesia management of a case of huge neck mass due to cervical spine chondrosarcoma with distorted anatomy

“…It was huge neck mass with anatomical distortion with tracheal deviation and restricted neck movement, airway management was difficult and challenging for the anesthetist. After discussing various techniques of difficult airway management like noninvasive McCoy laryngoscope, 5 Video laryngoscopy, 6 Airtraq video laryngoscope 7 (difficulty in negotiation), Fiberoptic intubation 8 (FOI) and invasive like retrograde intubation 9 (trauma, difficulty in retrieval of catheter), cricothyrotomy and percutaneous dilatational tracheotomy 10 we decided to go for FOI.…”