Misguidance of peroral rigid laryngoscopy in assessment of difficult airway: two comparable cases in microlaryngeal surgery

Zhang, Xu; Li, Wenxian

doi:10.1136/bcr-2012-008423

Cited by 3 publications

(1 citation statement)

References 11 publications

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“…The careful clinical examination that helped us in clenching the diagnosis was the presence of laryngeal widening, lack of laryngeal crepitus, and pooling of saliva in bilateral pyriform fossae on endoscopy. The presence of post-cricoid growth is not well appreciated in the rigid office-based sitting 70-degree endoscopy as it is a hidden area and is well appreciated during the direct laryngoscopy procedure [ 12 ]. The presence of pooling of saliva in both the pyriform fossae thus is a telltale indicator for evaluation of patients with direct laryngoscopy/ fiberoptic laryngoscopy and esophagoscopy.…”

Section: Discussionmentioning

confidence: 99%

Clinical Conundrum: Unveiling a Unique Presentation of Hypopharyngeal Carcinoma

Sahai,

Dixit,

Choudhary

et al. 2024

Cureus

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Dysphagia is a common symptom encountered in clinical practice, typically associated with a wide range of etiologies, including structural abnormalities, inflammatory conditions, neoplasms, and neurological disorders. However, the combination of subcutaneous emphysema, vocal cord palsy, enlarged arytenoids, and pooling of saliva in a dysphagic patient represents a rare and intriguing presentation. A 33-year-old female presented at a tertiary care hospital in Western India with hoarseness of voice, difficulty in swallowing, productive cough, and neck pain for two months with an abrupt increase in the severity of all symptoms in two days. A history of chewable tobacco use for six years was disclosed. Clinical evaluation revealed a thin build with platynychia and conjunctival pallor, dental staining, drooling of saliva, the presence of extensive subcutaneous emphysema on palpation of the neck, and absent laryngeal crepitus. Endoscopic evaluation was suggestive of right vocal cord palsy and enlarged, congested arytenoid cartilages, post-cricoid growth with pooling of saliva in bilateral pyriform fossae. A CT scan of the neck showed a 2x3 cm neoplastic growth in the hypopharynx, with subcutaneous emphysema and free air foci in the head and neck region, prompting an immediate tracheostomy and biopsy of the hypopharyngeal growth with Ryle’s tube insertion. Squamous cell carcinoma was confirmed on the biopsy report. Due to its rarity, the possible underlying cause of idiopathic subcutaneous emphysema should be sought whenever encountered in clinical practice since these patients are potentially misdiagnosed. A high index of suspicion among clinicians, along with a consideration of the constellation of other symptoms and clinical features of a possible underlying hypopharyngeal cancer whenever encountering such patients is of key importance for prompting further investigations and treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical Conundrum: Unveiling a Unique Presentation of Hypopharyngeal Carcinoma

Sahai,

Dixit,

Choudhary

et al. 2024

Cureus

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Indirect laryngoscopic assessment for the diagnosis of difficult intubation in patients undergoing microlaryngeal surgery

Türkay

Şentürk

Arslan

et al. 2016

Wien Med Wochenschr

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Preoperative rigid laryngoscopic examination and modified jaw thrust manoeuver during fibreoptic-assisted tracheal intubation for general anaesthesia

et al. 2021

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Preoperative laryngoscopic examination of the airway informs general anaesthesia management and planning. However, the same glottic opening view cannot always be obtained during direct laryngoscopy of anaesthetised patients. In this case report, a patient underwent preoperative rigid laryngoscopy due to medical history, and no problems were anticipated in performing tracheal intubation; however, the direct laryngoscopic view was a Grade 4 on the Cormack-Lehane Scale after anaesthesia induction. A jaw thrust manoeuvre to facilitate fibreoptic-assisted nasotracheal intubation was not feasible. In order to compensate, a modified method of jaw thrust was implemented, where both thumbs were placed on the floor of the patient’s mouth, leading to a successful result. Safe airway management should be implemented with proper planning based on a careful preoperative evaluation.

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Misguidance of peroral rigid laryngoscopy in assessment of difficult airway: two comparable cases in microlaryngeal surgery

Cited by 3 publications

References 11 publications

Clinical Conundrum: Unveiling a Unique Presentation of Hypopharyngeal Carcinoma

Clinical Conundrum: Unveiling a Unique Presentation of Hypopharyngeal Carcinoma

Indirect laryngoscopic assessment for the diagnosis of difficult intubation in patients undergoing microlaryngeal surgery

Preoperative rigid laryngoscopic examination and modified jaw thrust manoeuver during fibreoptic-assisted tracheal intubation for general anaesthesia

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