Modification of the LMA-Unique to facilitate endotracheal intubation

Abstract

decompressed by aspiration of its contents using a 16G needle. Approximately 150 mL of thick brown oily fluid was aspirated, resulting in dramatic collapse of the cyst (Figure 2). At this stage, the airway assessment revealed normal mouth opening with a Mallampati class 1 airway. Accordingly, it was deemed appropriate to proceed with general anesthesia following application of routine monitors. Following induction with thiopentone sodium 75 mg iv (5 mg·kg–1) and atracurium 7.5 mg iv (0.5 mg·kg–1), direct laryngoscopy revealed a laryngeal grade 1 view (Cormack and Lehane classification), and the patient’s trachea was intubated with a # 5 oral endotracheal tube. The patient’s lungs were ventilated and anesthesia and surgery proceeded without incident. Following complete excision of the lesion, the patient’s recovery was uneventful. Although collapsing a cyst by needle aspiration is a commonsense approach, surprisingly this technique has not been adequately highlighted in the literature.1 Only on five previous occasions has partial cyst decompression been reported to facilitate intubation.1 This is the first reported pediatric case of complete preanesthetic decompression of a giant sublingual dermoid cyst. Huge intra-oral cysts also hinder surgical access. Therefore, extra-oral submental access, median glossotomy, extended median glossotomy and mandibulotomy approaches have been described.2–4 They increase morbidity and are cosmetically unacceptable. The case reported herein illustrates that preanesthetic aspiration improves surgical access, thereby facilitating complete transoral excision of giant cysts. We wish to caution that needle aspiration of cyst is only a temporizing measure and it cannot be the definitive treatment. Although aspiration may occasionally fail due to the pultaceous nature of cyst content,1 we emphasize that it is worth attempting in every case. We extrapolate that this technique may be applicable in any huge cystic lesion of the oral cavity5 irrespective of its pathology.