Anesth Pain Med.  2024 Jul;19(3):256-260. 10.17085/apm.23151.

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

• Jin G
• Lee S
• Park J

• KMID: 2563566
• DOI: http://doi.org/10.17085/apm.23151

Abstract

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.

Keyword

Airway management; Overlooked; Underestimated; Intubation; Epiglottis adhesion; Unexpected; Abnormality

Figure

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  Fig. 1. Laryngoscopic findings: epiglottis adhesion to the posterior wall of the laryngeal cavity.

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  Fig. 2. Laryngoscopic findings: a view of the vocal cords between the adhesive epiglottis and uvula.

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  Fig. 3. Laryngoscopic findings: successful intubation through the vocal cords.

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