The value of preoperative endoscopic airway examination in complex airway management of a patient with supraglottic cancer

Abstract

The standard bedside airway assessment tests are poorly predictive for difficult tracheal intubation, and do not assess the presence of the inside pathology of the upper airway, such as base of the tongue lesions, glottic and vallecular lesions, pyriform sinus pathology, supraglottic tumors, etc. The preoperative endoscopic airway examination, also commonly called nasal endoscopy, or nasendoscopy, is the only technique that assesses the upper airway in its entirety, under dynamic conditions prior to induction of anesthesia, and is recommended for routine use by NAP4 even for high acuity cases. We present a case of a patient with a malignant partial upper airway obstruction and largely normal external airway exam where preoperative endoscopic airway examination findings were used in real-time to devise successful ventilation and intubation strategies.