Title : Awake fiberoptic intubation for airway management in a patient with an ulcer proliferative mass of the aryepiglottic Fold Obscuring Glottic opening
Abstract:
A 45-year-old female, Manju Devi, presented with a 6-month history of progressively changing voice, diculty breathing for the past month, and worsening dysphagia for the past two weeks, parcularly with solids. Direct laryngoscopy revealed an ulceroproliferave mass arising from the le aryepigloc fold, obscuring the gloc opening. Imaging with contrast-enhanced CT of the neck showed a lobulated, heterogeneous mass in the hypopharyngeal region, encroaching into the airway and involving the aryepigloc fold and pyriform sinus, raising concerns for a malignant lesion. Small reacve lymph nodes were idened in the le submandibular region and along the carod sheath.
Due to the locaon of the mass near the glos and the risk of complete airway obstrucon, securing the airway was a crical concern. An awake beropc bronchoscopy for endotracheal intubaon was chosen as the safest approach. The paent was prepped with local anesthesia to the airway using nebulised 10% lignocaine and 4% lignocaine spray to the
oral mucosa. Aer obtaining informed consent, the paent was posioned supine on the operang table. To facilitate the beropc intubaon, the paent’s neck was extended, and the head was laterally rotated 30 degrees to the le. This posioning helped opmise visualisaon of the gloc opening, which was obscured by the mass.
The beropc scope was carefully passed through the oral cavity, past the uvula, and into the laryngeal area. As the scope advanced, the ulceroproliferave mass was observed covering most of the glos, with only the anterior commissure visible. Aer further gentle manipulaon, including the use of a shoulder roll for addional neck extension and rotaon,a clearer view of the anterior two-thirds of the glos was achieved. A 6.5mm internal diameter endotracheal tube was advanced over the beropc scope and successfully posioned just above the carina. General anesthesia was then induced, and an excision biopsy of the growth was performed.
This case underscores the importance of careful preoperave airway evaluaon and the role of awake beropc intubaon in managing complex airway obstrucons. Proper paent posioning, including neck extension and lateral rotaon, proved crucial for successful intubaon in the presence of a mass obstrucng the gloc opening.This case emphasises the techniques used in the beropc intubaon and the careful posioning of the paent, which were crical for the success of the procedure.
