Abstract

Background: Vallecular cysts are a rare cause of difficult tracheal intubation. We report a case of difficult endotracheal intubation in an adult with symptomatic vallecular mass for surgical resection. The anesthetic plan was to carry out awake intubation under airway blocks and sedation with adequate maintenance of spontaneous respiration and also keeping tracheostomy as a standby option. Case description: In this case, laryngoscopy was challenging due to the size and extent of the vallecular mass to the lingual surface of epiglottis, thus necessitating gentle laryngoscopy to prevent catastrophic cyst rupture and pulmonary aspiration. The glottis was not visualized using flexible fiberoptic bronchoscope and video laryngoscope, which made intubation difficult. Endotracheal intubation was finally obtained by the help of an ENT surgeon using ENT rigid laryngoscope. At the end of surgery, the surgeon decided to proceed with tracheostomy due to risk of airway edema, bleeding and aspiration. Histopathology of epiglottic mass revealed that of a pleomorphic adenoma. Clinical relevance: Patients with vallecular or epiglottic mass are more likely to have difficult airways after induction of anesthesia. Anaesthesiologist should give paramount importance to pre-operative airway assessment, anticipating and handling difficult airway and intubation failure, and making prompt and correct choices in ensuring patient safety.

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