Title : Congenital aglossia- anticipated difficult airway and anaesthesiologists quest to secure it
Abstract:
Background: The congenital absence of the tongue, known as Aglossia congenita, is an exceptionally rare malformation. The anticipation of a difficult airway can be established through a mere clinical examination of the oral cavity.
Case Report: The case of congenital aglossia depicted above was referred from the Plastic Surgery department to the Department of Anesthesiology, AIIMS New Delhi for pre-anesthetic assessment, as the patient was scheduled for an MRI. A 2-year-old male, weighing 10 kg, presented with challenges in feeding, regurgitation of food from the nasal cavity, recurrent upper respiratory tract infections since birth, and difficulties in speech. Clinical examination revealed retrognathia, cleft palate, the soft palate touching the floor of the mouth with malalignment of the uvula, absence of the tongue, edentulous condition, and a reduced oropharyngeal space.
Discussion: This case presents an anticipated difficult airway, marked by retrognathia and a grade 3 cleft palate, posing challenges for mask ventilation and nasal intubation. The narrowed space makes the use of a supraglottic airway device challenging. Consequently, the only viable options remaining are awake oral intubation and tracheostomy. However, performing these procedures in the pediatric age group is complicated, especially in peripheral setups like MRI suites where advanced airway equipment may be unavailable.
A similar case, documented by Mohamed Hegaz, involved tracheostomy in a neonate with an uncomplicated uvula, highlighting the rarity and complexity of such situations. In our approach, we proactively secured a smaller-than-usual endotracheal tube in the operating room to mitigate the need for surgical airway manipulation.
Learning points: This case report highlights the challenge of establishing a definitive airway when backup plans for a difficult airway are limited.
