Laryngeal web as a result of Reinke’s oedema: a cause of difficult endotracheal intubation

Başaranoğlu, Gökçen; Erden, Veysel; Kökten, Numan; Verim, Ayşegül; Isikci, Yesim; Saitoglu, Leyla

doi:10.1093/bja/aei643

Cited by 7 publications

(4 citation statements)

References 2 publications

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“… 18 Unexpected difficult airways have been reported in patients with undiagnosed lingual tonsillitis, lingual thyroid, laryngeal papillomatosis and laryngeal web even after a thorough physical airway examination. 42 – 46 Although video laryngoscopic airway devices have been shown to improve laryngeal views, successful endotracheal intubations and successful first attempt intubations, the current findings suggest that the accuracy of airway assessments in emergency situations may be questionable.…”

Section: Discussionmentioning

confidence: 76%

The diagnostic validity of clinical airway assessments for predicting difficult laryngoscopy using a grey zone approach

Min

Kim

et al. 2016

J Int Med Res

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ObjectivesThe diagnostic validity of clinical airway assessment tests for predicting difficult laryngoscopy in patients requiring endotracheal intubation were evaluated using receiver operating characteristic (ROC) curve analysis and a grey zone approach.MethodsIn this prospective observational study, patients were evaluated during a pre-anaesthetic visit. Predictive airway assessment tests (i.e. Modified Mallampati [MMT] classification; upper lip bite test [ULBT]; mouth opening; sternomental distance; thyromental distance [TMD]; neck circumference; neck mobility; height to thyromental distance [HT/TMD]; neck circumference-to-thyromental distance [NC/TMD]) were performed on each patient and LEMON, Naguib, and MACOCHA scores were also calculated. In addition, laryngeal images were acquired and assessed for percentage of glottic opening (POGO) scores. A POGO score of zero was categorized as difficult laryngoscopy.ResultsThe incidence of difficult laryngoscopy was 14.4% (35/243). Although seven predictive airway assessments (i.e. MMT classification, ULBT, mouth opening, HT/TMD, NC/TMD, and the LEMON and Naguib models) predicted difficult laryngoscopy by ROC analyses, a grey zone approach showed that the parameters were inconclusive in approximately 70% of patients. From all the tests, the HT/TMD ratio showed the highest sensitivity (80.0%) and ULBT had the highest specificity (95.2%).ConclusionUsing the grey zone approach, all predictive airway assessment tests showed large inconclusive zones which may explain previous inconsistent results in the prediction of difficult laryngoscopy. Our results suggest that the usefulness of clinical airway evaluation tests for predicting difficult laryngoscopy remains controversial.Clinical trial registrationClinicalTrials.gov (NCT01719848)

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Section: Discussionmentioning

confidence: 76%

The diagnostic validity of clinical airway assessments for predicting difficult laryngoscopy using a grey zone approach

Min

Kim

et al. 2016

J Int Med Res

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“…Therefore biopsies are recommended especially in chronic smokers [7] [8]. Patients with Reinke's oedema pose a potential problem during intubation or after long term side effect of intubation [10] [11]. Our patient had an awake fiber optic intubation, so allowing her to maintain and secure airway as a first step of a difficult airway algorithm.…”

Section: Discussionmentioning

confidence: 99%

Reinke’s Oedema Presenting as Stridor: Implications for Otolaryngologists in Difficult Airway

Mohyuddin¹,

Sandhu²

2017

IJOHNS

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We demonstrated the importance of managing a patient who presented with stridor due to severe Reinke's oedema. The concept of managing difficult airway has thus been introduced for the otolaryngologists according to a plan of action as described by the American Society of Anaesthesiologist's difficult airway algorithm. Methods: A case report of interest and review of literature. PubMed search with keywords of difficult airway, stridor, awake intubation and Reinke's oedema was used. Result: Management of an anticipated difficult airway with awake fiberoptic intubation with backup strategies of direct laryngoscopies with Eshmann stylet and awake invasive intubation is highlighted. Conclusion: This case report demonstrated a definitive strategy of securing a difficult airway with obstruction at the glottis and highlighted the role of teamwork between otolaryngologist and anaesthesiologist to secure difficult airway.

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“…Reinke's edema can lead to formation of acquired laryngeal web, which may lead to difficult intubation. 10 Patients with suspected RE can present with airway problem during anesthesia. 11 Reinke's edema does not go away on its own and it needs to be identified and addressed properly before its treatment plan.…”

Section: Discussionmentioning

confidence: 99%

Management of Laryngeal Airway in Reinke's Edema: An Anesthetic Overview

2017

An International Journal of Otorhinolaryngology Clinics

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Reinke's edema (RE) is a benign polypoidal lesion of the vocal folds. The vocal folds show a white and translucent edema, confined into the superficial lamina propria. The lesions usually affect both vocal folds with fusiform appearance and even mobile during phonation. Hoarseness of voice is the most common clinical presentation in RE. Reinke's edema is often associated with smoking habit, gastroesophageal reflux, and voice abuse. It usually occurs in middle-aged male or postmenopausal women who have a long-term history of smoking. We hereby report a case of a large polypoidal RE who presented with ventilation difficulties during general anesthesia using positive pressure mask ventilation.

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Laryngeal web as a result of Reinke’s oedema: a cause of difficult endotracheal intubation

Cited by 7 publications

References 2 publications

The diagnostic validity of clinical airway assessments for predicting difficult laryngoscopy using a grey zone approach

The diagnostic validity of clinical airway assessments for predicting difficult laryngoscopy using a grey zone approach

Reinke’s Oedema Presenting as Stridor: Implications for Otolaryngologists in Difficult Airway

Management of Laryngeal Airway in Reinke's Edema: An Anesthetic Overview

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