Laryngoscopy-assisted fiberoptic intubation in an adult with a large vallecular haemangioma

Kumar, Rajesh; Sahay, Nishant; Bharti, Bhartendu; Kumar, Ashish

doi:10.4103/ija.ija_157_20

Cited by 3 publications

(3 citation statements)

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“…[ 23 ] There are a few case reports discussing the management of difficult airways, such as cervical spine ankylosis due to rheumatoid arthritis or large vallecular hemangiomas, by using DL- or VL-assisted FOB-guided intubation. [ 24 , 25 ] Also, there are case reports of using DL and ELM together, to assist FOB-guided intubation and to overcome airway obstruction from perilaryngeal edema. [ 26 ] In our patient, a McGrath video laryngoscope was inserted, and the jaw and the tongue were lifted with the blade to expand the space for the rotating NIM tube to pass through the airway.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies report improved level of difficulty when laryngoscope is combined during FOB-guided intubation, [23] and by using laryngoscope, effects of both jaw thrust and lingual traction can be expected and the airway can be cleared [23] . There are a few case reports discussing the management of difficult airways, such as cervical spine ankylosis due to rheumatoid arthritis or large vallecular hemangiomas, by using DL- or VL-assisted FOB-guided intubation [24,25] . Also, there are case reports of using DL and ELM together, to assist FOB-guided intubation and to overcome airway obstruction from perilaryngeal edema [26] .…”

Section: Discussionmentioning

confidence: 99%

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Fiberoptic-guided nerve integrity monitoring tube intubation assisted by video-laryngoscope with external laryngeal manipulation in a patient with anteriorly displaced larynx due to huge goiter with retropharyngeal involvement

et al. 2022

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Rationale: Goiter, an abnormal enlargement of the thyroid gland, can induce airway distortion or tracheal compression. Airway management can be challenging for anesthesiologists, depending on the location and size of the mass as well as the patient's airway conditions, although it is reported that most cases can easily be managed by oral intubation.Patient concerns: A 61-year-old female patient who had planned for a total thyroidectomy due to a huge goiter was intubated with nerve integrity monitoring (NIM) tubes, using video laryngoscopy (VL) and oral fiberoptic bronchoscopy (FOB) alone. The respective attempts initially failed.Diagnosis: The patient's thyroid mass extended from the C3 cervical spine level to the T1 thoracic spine level with retropharyngeal involvement, causing an upper airway anatomical alteration that made intubation difficult. FOB manipulation was challenging due to the acute angulation of the laryngeal inlet and the tongue and the consequent interruption by the epiglottis. There was resistance to tube introduction, despite counterclockwise rotation of the NIM tube, due to acute angulation of the larynx and circumferential narrowing of the oropharyngeal and supraglottic space.Interventions: In the first step of FOB-guided intubation, external laryngeal manipulation (ELM) was performed to improve the angle of the glottic opening and to elevate epiglottis tip. This allowed for FOB introduction into the trachea. VL was then performed transorally to elevate the tongue base and increase space, using the blade. ELM was applied simultaneously to move the glottis lower, thereby reducing the angle of the tube passage.Outcomes: The NIM tube was successfully introduced into the trachea with counterclockwise rotation in FOB-guided intubation.Lessons: The combination of techniques using basic and popular devices and maneuvers, such as ELM and VL, may be useful for the successful management of difficult airways related to retropharyngeal goiter, without the need for surgical airway.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fiberoptic-guided nerve integrity monitoring tube intubation assisted by video-laryngoscope with external laryngeal manipulation in a patient with anteriorly displaced larynx due to huge goiter with retropharyngeal involvement

et al. 2022

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“…The original research and other articles in this issue of the IJA are just an example, of how life can continue in the world of research academics even during these difficult COVID times. [ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ] Over the last 6 months, IJA has received almost 25–30% of the manuscripts on COVID. It is almost near to impossible for the editorial board members to do justice to such a huge deluge of academic material in a short period but still, somehow they are managing the academic load of IJA by taking the time out from their precious family and professional schedules.…”

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confidence: 99%

Editing from the dungeons of the pandemic; an editor's agonisingly painful battle with COVID-19

Bajwa

2020

Indian J Anaesth

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Direct Laryngoscopy-Assisted Flexible Bronchoscopic Intubation in a Difficult Airway

Wagh

2023

Airway

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Laryngoscopy-assisted fiberoptic intubation in an adult with a large vallecular haemangioma

Cited by 3 publications

References 4 publications

Fiberoptic-guided nerve integrity monitoring tube intubation assisted by video-laryngoscope with external laryngeal manipulation in a patient with anteriorly displaced larynx due to huge goiter with retropharyngeal involvement

Fiberoptic-guided nerve integrity monitoring tube intubation assisted by video-laryngoscope with external laryngeal manipulation in a patient with anteriorly displaced larynx due to huge goiter with retropharyngeal involvement

Editing from the dungeons of the pandemic; an editor's agonisingly painful battle with COVID-19

Direct Laryngoscopy-Assisted Flexible Bronchoscopic Intubation in a Difficult Airway

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