Abstract
We demonstrated the importance of managing a patient who presented with stridor due to severe Reinke’s oedema. The concept of managing difficult airway has thus been introduced for the otolaryngologists according to a plan of action as described by the American Society of Anaesthesiologist’s difficult airway algorithm. Methods: A case report of interest and review of literature. PubMed search with keywords of difficult airway, stridor, awake intubation and Reinke’s oedema was used. Result: Management of an anticipated difficult airway with awake fiberoptic intubation with backup strategies of direct laryngoscopies with Eshmann stylet and awake invasive intubation is highlighted. Conclusion: This case report demonstrated a definitive strategy of securing a difficult airway with obstruction at the glottis and highlighted the role of teamwork between otolaryngologist and anaesthesiologist to secure difficult airway.
Highlights
Reinke’s oedema is fluid collection in the lamina propria of the true vocal cords, which is one of the five layers, deep to the squamous epithelial layer, and superficial to the superficial layer of the lamina propria of the true vocal fold [1]
The concept of managing difficult airway has been introduced for the otolaryngologists according to a plan of action as described by the American Society of Anaesthesiologist’s difficult airway algorithm
Result: Management of an anticipated difficult airway with awake fiberoptic intubation with backup strategies of direct laryngoscopies with Eshmann stylet and awake invasive intubation is highlighted. This case report demonstrated a definitive strategy of securing a difficult airway with obstruction at the glottis and highlighted the role of teamwork between otolaryngologist and anaesthesiologist to secure difficult airway
Summary
Reinke’s oedema is fluid collection in the lamina propria of the true vocal cords, which is one of the five layers, deep to the squamous epithelial layer, and superficial to the superficial layer of the lamina propria of the true vocal fold [1]. We describe a difficult airway case with Reinke’s oedema involving the vocal cords especially the left vocal cord which has formed a sac like collection. Sandhu 12 causing stridor due to ball valve effect. We demonstrated this unusual presentation with stridor and highlighted the use of fiber optic intubation for securing the supra-glottic airway and performing the micro laryngeal surgery as a joint team effort between the otolaryngologist and anaesthesiologist. The otolaryngologist should be aware of the anticipated difficult airway and bring in the necessary skills of using fiber optic intubation, more recently video-laryngoscopy, different laryngoscopes, rigid bronchoscopes or surgical tracheostomy as necessary techniques for securing the difficult airway
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