Lingular Tonsillar Hypertrophy and the Difficult Airway

Abstract

To the Editor: The Journal has a responsibility to accurately present standards of patient care to its readership. In a recent case report of hypoxemic brain injury and death after intubation failure due to lingular tonsillar hypertrophy, Jones and Cohle [1] did not discuss airway management in relation to current guidelines [2,3]. Practice guidelines for management of the difficult airway do not recommend attempting fiberoptic intubation in patients who cannot be adequately ventilated by mask, as the authors did in their case report. Needle or surgical cricothyrotomy, however, is the recommended management of upper airway obstruction with failed intubation and inadequate ventilation. Although the pathologic specimen in the postmortem photograph is impressive, the anatomy below the larynx is clearly normal and accessible. Unfortunately, the publication of this case lends a misplaced veneer of credibility to the management approach which it describes. James E. Renwick, MD, FRCPC Craig R. Ries, MD, FRCPC Department of Anaesthesia, The University of British Columbia, Vancouver, British Columbia V6T 2B5, Canada