Anesth Pain Med.  2020 Jan;15(1):73-77. 10.17085/apm.2020.15.1.73.

Successful wire-guided fiberoptic nasotracheal intubation in a patient with hemifacial microsomia - A case report -

• Kim SJ
• Lee H
• Choi SY
• Koo BN

• KMID: 2500458
• DOI: http://doi.org/10.17085/apm.2020.15.1.73

Abstract

Background
Patients with hemifacial microsomia may have a difficult airway due to the accompanying mandibular deformity. Fiberoptic bronchoscope-guided intubation is commonly used method for difficult airway management. However, awake fiberoptic nasotracheal intubation has several disadvantages, including difficulty in advancement of the endotracheal tube (ETT) due to the resistance between the ETT and bronchoscope. Wire-guided fiberoptic nasotracheal intubation may help to overcome the drawbacks of the conventional method. Case: An 18-year-old man with hemifacial microsomia was scheduled for double-jaw surgery. In preoperative evaluation, he had severe retrognathia and expected difficult airway. We successfully performed wire-guided fiberoptic nasotracheal intubation combined with high-flow nasal cannula and deep sedation without any complications.
Conclusions
A guidewire may be useful, in case of difficultly in advancing the ETT or if a smaller tube is required, while performing intubation with FOB in patients with difficult airways.

Keyword

Bronchoscopes; Goldenhar syndrome; Intubation

Figure

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  Fig. 1 Narrowing of the nasopharyngeal airway seen on the oral panoramic view X-ray (double-headed arrow).

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  Fig. 2 Angio Guidewire and airway exchange catheter set A: straighttipped Angio Guidewire (Lunderquist-ring, Cook Critical Care), B: exchange catheter (CAEC, Cook Critical Care), C: bronchoscope airway adapter, D: Rapi-Fit® adapter.

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  Fig. 3 The fiberoptic bronchoscope showing that the guidewire is positioned in the trachea A: left main bronchus, B: right main bronchus, C: carina, Empty arrow: guide wire.

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  Fig. 4 The guidewire passing through the vocal cord and into the trachea as seen with the Glidescope® A: epiglottis, B: arytenoid cartilage, Empty arrow: guide wire.

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