Difficult intubation due to interarytenoid adhesion: A case report

Park, Sang Jin; Song, Sun Ok; Hwang, Chang Jae

Abstract

Interarytenoid adhesion of the vocal cords, with a triangular anterior opening and a smaller posterior rounded opening, is one of the complications of intubation. The vocal cords are tethered to each other and they are restricted with narrow abduction, causing difficult intubation. A 57-year-old woman was scheduled to undergo lung wedge resection. The patient had experienced a prolonged intubation 15 years previously. Thereafter, she had undergone two operations and intubation was difficult to perform with using small size endotracheal tubes (6.5 and 6.0 mm inner diameter, respectively). Despite this past medical history, anesthesia was performed without further evaluation because of the patient's refusal. After the failure of an initial trial of intubation with a double lumen endobronchial tube, we tried to intubate with a small sized endotracheal tube (5.0 mm). But it was impossible to pass the tube through the vocal cords. Endobronchial endoscopy revealed interarytenoid adhesion of her vocal cords. After tracheostomy, she received wedge resection. Therefore, the possibility of difficult intubation due to interarytenoid adhesion of the vocal cords should be considered for a patient with a past history of intubation.