Difficult Endotracheal Intubation Due to an Asymptomatic Epiglottic Cyst

Abstract

Airway problems are easiest to manage when they are anticipated. Difficult intubation might, however, occur in patients with no obvious signs or symptoms suggesting airway obstruction. We describe a case of difficult intubation where the laryngeal inlet was obscured by a large epiglottic cyst that was discovered during rapid-sequence induction of general anesthesia. A 3-year-old male weighing 15㎏ was admitted for an emergency appendectomy. After preoxygenation, a rapid-sequence induction was carried out. Direct laryngoscopy (Macintosh # 1 blade) revealed a large 2-㎝ cyst arising from the lingual surface of the epiglottis. The cyst completely obstructed the view of the epiglottis and larynx, and several attempts at endotracheal intubation were unsuccessful. Fortunately, the patient was mask ventilated without difficulty and oxygen saturation was 98 - 99%. After a second 10㎎ dose of succinylcholine, intubation was attempted using the same laryngoscope blade and a styletted 4.5㎜ endotracheal tube by another anesthesiologist as cricoid pressure was maintained. By using the tube to push the cyst upward, intubation of the trachea was performed after a brief view of the arytenoid cartilages. Anesthesia and the operation then proceeded uneventfully. Following an appendectomy, an ENT surgeon removed the cyst. (Korean J Anesthesiol 2002; 42: 685-689)