Massive Ameloblastoma Requiring Awake Nasal Fiberoptic Intubation

Abstract

Ameloblastomas are rare tumors that arises from the odontogenic epithelium. Although benign and slow growing, an extensive lesion may cause airway obstruction, making bag-mask ventilation and intubation a significant challenge. Here, we present a 54-year-old male in respiratory distress with an 18x15x13 cm submandibular mass causing airway compromise. The tumor was extensive, occupying most of the oral cavity. Unable to perform direct laryngoscopy because of the tumor burden, we performed an awake nasal fiberoptic intubation to secure the airway. Successful intubation was achieved as well as subsequently tracheostomy. We subsequently provide a discussion on associated challenges and management options for patients with ameloblastomas.

Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

“…When appropriate, awake (oral or nasal) intubation should be considered if the difficult airway of the patient is suspected (e.g., difficult ventilation, increased risk of aspiration, short apneic tolerance, expected difficulty with emergency invasive airway rescue) [28]. Typical examples include a huge tumor over head and neck [49,50] or undergoing oral maxillofacial surgery [51]. It should be emphasized that awake FOB is still the gold-standard tracheal intubation for such intractable and difficult airway scenarios, although other modified intubation modalities have been mentioned.…”