Unexpected difficult intubation due to lingual tonsillar hyperplasia in a thoracotomy patient: intubation with the double-lumen tube using stylet and fiberoptic bronchoscopy

Orhan, Mehmet Emın; Gözübüyük, Alper; Sızlan, Ali; Dere, Umur

doi:10.1016/j.jclinane.2008.10.016

Cited by 6 publications

(10 citation statements)

References 20 publications

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“…Difficult intubation can be due to a number of causes. Pathologies like enlarged lingual tonsil [1], valecular or epiglottic cysts [2], laryngeal papillomas, hyperplastic mucosal folds, oropharyngeal stenosis [3] lead to difficulty visualizing the larynx. Tracheal stenosis [4], congenital [5] or acquired laryngeal webs [6], tumors of the larynx [7], airway trauma, subglottic stenosis and undetected mediastinal masses lead to difficulty in advancing the endotracheal tube.…”

Section: Discussionmentioning

confidence: 99%

Caught in the subglottic web-unanticipated difficult intubation

Sabapathy¹,

Kulkarni²,

Hanumanthappa³

et al. 2018

biomedicalresearch

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Unanticipated difficult airway still forms about 93% of the total number of difficult airway scenarios encountered. Difficult airway can be due to difficulty in mask ventilation, difficult laryngoscopy or difficulty in intubation. Difficult intubation can be due to a number of causes. Pathologies like enlarged lingual tonsil, valecular or epiglottic cysts, laryngeal papillomas, hyperplastic mucosal folds, oropharyngeal stenosis lead to difficulty visualizing the larynx. Tracheal stenosis, laryngeal webs, tumors of the larynx, airway trauma and undetected mediastinal masses lead to difficulty in advancing the endotracheal tube. Management of these cases is always challenging. Although a thorough history that includes previous endotracheal intubation, weight changes, episodes of dyspnea or wheeze may help identify at risk patients, very often these patients may be asymptomatic and the pathology may not be until the time of laryngoscopy and intubation. At the time of unanticipated crisis, following the stepwise protocol of difficult airway and being prepared for surgical airway access can prevent complications and save the life of the patient. Here we present two such cases of unanticipated difficult airway how we managed them. Post-operatively these patients were found to have laryngeal webs.

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Section: Discussionmentioning

confidence: 99%

Caught in the subglottic web-unanticipated difficult intubation

Sabapathy¹,

Kulkarni²,

Hanumanthappa³

et al. 2018

biomedicalresearch

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“…When present, symptoms rise due to mechanical compression/ obstruction and patients usually complain of non-specific symptoms such as tongue paraesthesia, dysphagia, and throat discomfort and dyspnea 3 . It is necessary to prepare a difficult airway management including laryngeal mask airway, fiberoptic bronchoscopy and transcutaneous tracheotomy set 4,5 . Macintosh laryngoscopy failed to expose a glottis by two experienced anesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

Massive benign lingual tonsil hyperplasia and tracheostomy

Cukic¹,

Nikolić²,

Jovanović³

2017

Materia medica

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ApstraktOpisujemo slučaj prekomerne hipersplazije lingvalne tonzila kod odraslih uprkos prethodnoj tonzilektektomiji koja je zahtevala inicijalnu traheostomiju da bi se kompletno uklonilo limfoidno tkivo. Raspravljamo o poteškoćama u intubaciji u proceni disajnih puteva. AbstractWe describe a case of excessive lingual tonsil hyperplasia in adult despite previous tonsillectomy which required initial tracheostomy to complete removal of lymphoid tissue. We discuss intubation difficulties in evaluation of airway.

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“…60,66 The incidence of difficult and impossible facemask ventilation was higher in the LTH cases than that reported in the general population (29.6 vs. 1.4% and 1.4% vs. 0.16%, respectively). 69 Facemask ventilation may be more difficult as the LTH may distort the supraglottis, 2,19,23,25,26,36,38,39 or overhang the borders of the epiglottis and cause airway obstruction. 2 Posterior displacement of the tongue may limit airflow from both nasal and oral routes, and an increased thickness of the tongue base is a predictor of difficult face mask ventilation.…”

Section: Awake Tracheal Intubation May Be the Best Option For Known S...mentioning

confidence: 99%

Airway management of lingual tonsillar hypertrophy: A narrative review

Wong,

Sleigh

2023

Anaesth Intensive Care

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Lingual tonsillar hypertrophy is rarely identified on routine airway assessment but may cause difficulties in airway management. We conducted a narrative review of case reports of lingual tonsillar hypertrophy to examine associated patient factors, success rates of airway management techniques and complications. We searched the literature for anaesthetic management of cases with lingual tonsillar hypertrophy. We found 89 patients in various case reports, from which we derived 92 cases to analyse. 64% of cases were assessed as having a normal airway. Difficult and impossible face mask ventilation occurred in 29.6% and 1.4% of cases, respectively. Difficult intubation and failed intubation occurred in 89.1% and 21.7% of cases, respectively. Multiple attempts (up to six) at intubation were performed, with no successful intubation after the third attempt with direct laryngoscopy. Some 16.5% of patients were woken up and 4.3% required emergency front of neck access. Complications included oesophageal intubation (10.9%), bleeding (9.8%) and severe hypoxia (3.2%). Our findings show that severe cases of lingual hypertrophy may cause an unanticipated difficult airway and serious complications, including hypoxic brain damage and death. A robust airway strategy is required which includes limiting the number of attempts at laryngoscopy, and early priming and performance of emergency front of neck access if required. In patients with known severe lingual tonsillar hypertrophy, awake intubation should be considered.

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Unexpected difficult intubation due to lingual tonsillar hyperplasia in a thoracotomy patient: intubation with the double-lumen tube using stylet and fiberoptic bronchoscopy

Cited by 6 publications

References 20 publications

Caught in the subglottic web-unanticipated difficult intubation

Caught in the subglottic web-unanticipated difficult intubation

Massive benign lingual tonsil hyperplasia and tracheostomy

Airway management of lingual tonsillar hypertrophy: A narrative review

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