Diffuse idiopathic skeletal hyperostosis of cervical spine - An unusual cause of difficult flexible fiber optic intubation

Baxi, Vaibhavi; Gaiwal, S.

doi:10.4103/1658-354x.62609

Cited by 9 publications

(9 citation statements)

References 13 publications

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“…The severity of the airway compromise is dependent upon the vertebrae levels involved and the amount and orientation of the bone deposited. The protruding osteophytes anteriorly could impinge upon the posterior wall of pharynx, and cause narrowing at the corresponding laryngopharynx and trachea (5). Lateral radiological imaging could help identifying "bony" structure and could be used as an indicator for preoperative airway assessment.…”

Section: Discussionmentioning

confidence: 99%

A rare case of an unexpected difficult airway management in a diffuse idiopathic skeletal hyperostosis patient and post-operative airway evaluation with 3D printing technique

Zhang¹,

Wang²,

Liu³

et al. 2021

Ann Transl Med

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Diffuse idiopathic skeletal hyperostosis (DISH), asymptomatic in most cases, is a degenerative condition that commonly leads to anterior cervical osteophytes in most elderly patients. Clinically significant airway compression is rare. However, in some cases, the seemingly insignificant osteophytes could become a threat to airway management during intubation. Here we present a case of an 82-year-old man diagnosed as DISH and scheduled for cervical surgery. Radiographic imaging did not indicate the airway compromise.Preoperative airway assessment indicated modified Mallampati scoring of class III. However, an unexpected large bulge protruding from posterior pharyngeal wall blocked video laryngoscopy assisted intubation.Intubation with direct laryngoscope, laryngeal mask airway (LMAD) and Shikani optical stylet were failed.Only flexible fiberoptic nasal intubation was performed successfully. After surgery, an anatomically matched and patient-specific 3D printed model was made to help more direct and comprehensive estimation of the size and the location of the osteophyte. The relationship of the airway compromise and osteophytes was revealed in DISH patients for the first time with the aid of 3D printed model. The eccentric growth of the cervical osteophytes occupied large portion of the laryngopharynx space and prohibited the direct placement of the tracheal tube. This case is a rare presentation of the management of a DISH patient with unexpected difficult airway. We propose for the first time that different intubation strategies should be considered for potential difficulty airway in DISH patients according to the size and location of the osteophytes. For potential difficult airway management of DISH patients, 3D printing technique is a promising way of preoperative airway assessment.

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Section: Discussionmentioning

confidence: 99%

A rare case of an unexpected difficult airway management in a diffuse idiopathic skeletal hyperostosis patient and post-operative airway evaluation with 3D printing technique

Zhang¹,

Wang²,

Liu³

et al. 2021

Ann Transl Med

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“…Some reports mentioned difficult intubation due to mass-like protrusion of posterior pharyngeal wall as in our case. [ 10 11 12 ] Aziz et al . [ 13 ] had difficulty in insertion of intubating laryngeal mask airway due to the same reason.…”

Section: Discussionmentioning

confidence: 99%

“…There are reports stating the need of tracheostomy or reintubation in postoperative as well as preoperative period. [ 11 12 ] Hence, we decided to extubate the patient on an airway exchange catheter. Furthermore, prophylactic steroid shot was given in premedication to prevent laryngeal edema.…”

Section: Discussionmentioning

confidence: 99%

Airway management in case of diffuse idiopathic skeletal hyperostosis

2018

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Diffuse idiopathic skeletal hyperostosis (DISH) is associated with abnormal ossification of spinal and extraspinal appendages. Incidence of DISH is high in old age with predilection for males. Cervical hyperostosis can make intubation difficult in multiple ways. Here, we report a case of DISH bridging the cervical spine from C2 to C7 vertebrae managed using awake fiberoptic technique and a small-sized endotracheal tube.

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“…Of these, 34 full-text articles were evaluated, and 23 papers were potential candidates. One article was excluded because the full text could not be found [7], leaving 22 articles (summarized in Table 1) [5,6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The excluded articles are presented in the appendix.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Among the patients included, the most commonly involved cervical vertebrae were C3-C4, followed by C4-C5 and C5-C6, leading to dysphagia and airway obstruction, possibly due to excessive activity. Six patients had no symptoms before intubation [5,6,10,12,14,21], and the rest of the patients had symptoms such as dysphagia, dysphonia, dyspnea, airway obstruction, or restricted motion of the neck [8,9,11,13,[15][16][17][18][19][20][22][23][24][25][26][27]. Awake intubation was chosen for 10 patients [5, 11, 13-15, 20, 22-25], and rapid induction was chosen for 7 patients [6,8,9,16,17,21,23]; fiberscope-assisted intubation was cited as the optimal choice in 13 articles [11, 13-15, 18, 20-27]; other cases favored the direct laryngoscope [5,6,9,16,17,19,23] or the intubating laryngeal mask [13,21].…”

Section: Literature Reviewmentioning

confidence: 99%

Ossification of the cervical anterior longitudinal ligament is an underdiagnosed cause of difficult airway: a case report and review of the literature

Liu

Yang

et al. 2020

BMC Anesthesiol

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Background: Ossification of the anterior longitudinal ligament (OALL) of the cervical spine is a common, but rarely symptomatic, condition mostly observed in the geriatric population. Although the condition usually requires no intervention, it could lead to a difficult airway and compromise the patient's safety. Case presentation: Here, we describe the case of a 50-year-old man with cervical myelopathy and OALL that resulted in difficult endotracheal intubation after induction of anesthesia. Radiography and magnetic resonance imaging findings showed OALL, with prominent osteophytes involving four cervical vertebrae, a bulge in the posterior pharyngeal wall, and a narrow pharyngeal space. Airtraq® laryngoscope-assisted intubation was accomplished with rapid induction under sevoflurane-inhaled anesthesia. Conclusion: Anesthesiologists should understand that OALL of the cervical spine could cause a difficult airway. However, it is difficult to recognize asymptomatic OALL on the basis of routine airway evaluation guidelines. For susceptible populations, a thorough evaluation of the airway, based on imaging studies and a history of compression symptoms, should be considered whenever possible. In case of unanticipated difficult intubation, anesthesiologists should refer to guidelines for unanticipated difficult airway management and identify OALL of the cervical spine as the cause.

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Diffuse idiopathic skeletal hyperostosis of cervical spine - An unusual cause of difficult flexible fiber optic intubation

Cited by 9 publications

References 13 publications

A rare case of an unexpected difficult airway management in a diffuse idiopathic skeletal hyperostosis patient and post-operative airway evaluation with 3D printing technique

A rare case of an unexpected difficult airway management in a diffuse idiopathic skeletal hyperostosis patient and post-operative airway evaluation with 3D printing technique

Airway management in case of diffuse idiopathic skeletal hyperostosis

Ossification of the cervical anterior longitudinal ligament is an underdiagnosed cause of difficult airway: a case report and review of the literature

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