Abstract

Massive thyroid enlargement can significantly distort upper airway anatomy by causing tracheal compression, lateral deviation, and restricted neck mobility, thereby increasing the risk of difficult mask ventilation and tracheal intubation. Induction of general anaesthesia before securing the airway in such patients may precipitate airway collapse and catastrophic hypoxia. We report the case of a 55-year-old female presenting with a progressively enlarging anterior neck swelling and mild dyspnoea, with clinical features suggestive of an anticipated difficult airway. Preoperative assessment revealed distorted airway anatomy, limited neck extension, and possible tracheal compression. A planned strategy of awake fibreoptic intubation (FOI) was adopted following comprehensive airway topicalisation using lignocaine nebulisation and targeted superior laryngeal and transtracheal nerve blocks. Awake oral fibreoptic intubation was successfully performed while preserving spontaneous ventilation. General anaesthesia was subsequently induced, and thyroid surgery proceeded uneventfully. The patient was extubated after full recovery and monitored postoperatively without airway complications. This case highlights the importance of meticulous airway assessment. It demonstrates awake fibreoptic intubation as a safe and reliable technique in patients with massive thyroid enlargement and an anticipated difficult airway.

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