Unanticipated Difficult Nasal Intubation Due to a Prominent Anterior Tubercle of the First Cervical Spine

Abstract

Nasal intubation is frequently used for airway management in patients undergoing many surgical procedures. This is a case report of an unanticipated difficult nasal intubation due to a prominent anterior tubercle of the first cervical spine vertebra (C1) resulting in aspiration of blood and hypoxemia following intubation. The subsequent airway management of the rescheduled elective case is also described. The specific difficulties in securing the airway for nasal intubation are described as well as the management strategies to circumvent this anatomical variant. This case report will be of interest to health care practitioners providing airway management via the nasal route for different populations.

Gum elastic bougie as a guide in nasotracheal intubation: A novel technique

“…Furthermore, Watton and Hung have reported a difficulty due to prominent anterior tubercle of the C1. [2]…”

“…[2] Besides, the trauma caused by the repeated attempts can increase the bleeding and lower the chances of subsequent successful intubation.…”

“…[2] Suggestion has been made to use flexible atraumatic catheter such as tube exchanger and urinary catheter to guide the passage of ETT through the nostrils into the nasopharynx. [2]…”