Difficult airway associated with bifid glottis and coexistent subglottic stenosis in a patient with Pallister-Hall syndrome: a case report

Intubation of underestimated airway in a patient with epiglottis adhesion to the posterior wall of the laryngeal cavity -A case report

BACKGROUND

Epiglottis abnormality is rare condition and can lead embarrassing intubation to anesthesiologists. Here, we reported a case of successful management in a patient with unexpected hidden vocal cords due to epiglottis adhesion to the posterior wall of the laryngeal cavity.

CASE

A 60-year-old female with no underlying disease was scheduled for general anesthesia to undergo a left-cochlear implant operation. After the induction procedure (including intravenous injection of rocuronium), an epiglottic adhesion to the posterior wall of the laryngeal cavity and invisible vocal cords were confirmed. Although the first trial of intubation failed, the patient's airway was successfully managed using a technique that combined a video-styletscope (Markstein Sichtec Medical Co., 5.0 mm ID) with a video-laryngoscope (Insighters ®, Cedrus Medical).

CONCLUSIONS

Anesthesiologists may unexpectedly encounter asymptomatic abnormal airways with unknown causes. In such a situation, it is essential to establish a strategy and to select appropriate device according to patient circumstances.

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.