Abstract
Surgery for laryngeal cancer and the following recurrent tumor growth may further change the anatomy of the airway. Airway management during anesthesia induction is challenging for the patients undergoing secondary surgery due to recurrence of laryngeal cancer or its postoperative complication, but it has never been reported. In this report, we described three cases of anesthetic induction which had different process of airway events. The first case was given intravenous general anesthetic for induction and experienced failed intubation, difficult mask ventilation and emergent tracheostomy, eventually were rescued successfully. The second case presented a fixed metastatic mass about 6 cm diameter upon the primary surgical scar of incision and preoperative apnea, underwent fibroscopy-guided conscious intubation and the process was uneventful. The third case had erythema and swelling under the mandible with erupted ulcer as well as neck immobility due to recurrent tumor. The anesthesiologist attempted fibroscopy-guided intubation via nasal passage with a tracheal tube in 2.8 mm diameter but it was failed. Subsequently, tracheostomy was performed under bilateral superficial cervical plexus block and the dissected larynx by operation verified distorted structure of glottis with S-shaped stenosis. This report concludes that, during the anesthetic induction for this special type of surgery, a detailed and comprehensive evaluation of the airway, and a routine fibroscopic examination are especially important.
Highlights
Laryngeal cancer accounts for about 50% of head and neck malignant tumors and the ratio of male to female occurrence is 4:1 [1]
It has been well established that the presence of laryngeal cancer may lead to difficulties in airway management both in term of difficult mask ventilation and tracheal intubation [6, 7]
For recurrent laryngeal cancer surgery, special considerations are necessary, and a safe airway management strategy should be planned in cases of stenosis, metastasis, contracture of the previous incision scar and dermal tension in the cervical area resulting from radiation therapy [8,9,10,11]
Summary
Laryngeal cancer accounts for about 50% of head and neck malignant tumors and the ratio of male to female occurrence is 4:1 [1]. It has been well established that the presence of laryngeal cancer may lead to difficulties in airway management both in term of difficult mask ventilation and tracheal intubation [6, 7]. No abnormality was detected with preoperative physical examination and CT scan showed increased lung markings without metastasis It demonstrated moderate general condition with 3 cm of mouth opening, ECG with right bundle block, Malampatti grade II, without complaint of apnea or major depression signs. A 63-years old male, diagnosed with recurrent laryngeal cancer after semi-laryngectomy 8 months ago, was scheduled to undergo total laryngectomy. He has 17 years’ history of hypertension and his echocardiography revealed mild impairment of the left ventricular diastolic function. Dissection of the excised larynx verified the distorted structure of the glottis with an S-shaped stenosis
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