Management of an expected severe airway for intubation – a case report

Introduction

Exertional dyspnea that had been progressive for 5 months in a 77-year-old female patient in a cardiac exercise group was the reason for referral to the hospital. A cardiac or pulmonary cause, which initially seemed most likely, was ruled out.

Case Presentation 

The patient's medical history revealed additional swallowing difficulties that had been present for three weeks. Flexible laryngoscopy ultimately revealed a globular, most likely cystic subepithelial mass originating from the aryepiglottic fold on the left and almost completely filling the aditus laryngis.

Even for fiberoptic awake intubation, this large benign mass would have posed an intubation obstacle. In order to avoid a coniotomy or tracheostomy in this particular case, indirect relief of the cyst was performed under local aneasthesia and the following day, problem-free videolaryngoscopic intubation was performed to ablate the cystic sac, which was subsequently confirmed histologically as a benign retention cyst.

Discussion 

The poster describes the findings and this variant of the procedure with expected difficult intubation during microlaryngoscopy.

Publication History

Article published online:
13 June 2022