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Oral styletted intubation under video control in a patient with a large mobile glottic tumour and a difficult airway

[L'intubation orale avec un stylet vidéoguidé chez un patient présentant une importante tumeur mobile de la glotte et une intubation difficile]

Ichiro Takenaka, MD^*, Kazuyoshi Aoyama, MD, Motohiro Nakamura, MD^*, Hiroshi Fukuyama, MD^*, Yasunari Urakami, MD^*, Yukari Takenaka, MD and Tatsuo Kadoya, MD^*

^* From the Departments of Anesthesia, Nippon Steel Yawata Memorial Hospital,
the Moji Rosai Hospital, and
the Emergency Life Saving Technique Academy, Kitakyushu, Japan.

Address correspondence to: Dr. Ichiro Takenaka, Department of Anesthesia, Nippon Steel Yawata Memorial Hospital, 1-1-1 Harunomachi, Yahatahigashi-ku, Kitakyushu 805-8508, Japan. Phone: 81-93-671-9420; Fax: 81-93-671-9605; E-mail: itaken{at}d4.dion.ne.jp

Purpose: With fibreoptic intubation, advancement of the endotracheal tube (ETT) through the glottis is blind. Thus, in patients with a laryngeal tumour, there is a potential for damage to the tumour. Previously, we proposed the use of a fibreoptic bronchoscope (FOB)-video camera system to permit visualization of tube passage. We used this technique successfully in a patient with a known difficult airway and a large glottic tumour.

Clinical features: A 61-yr-old man with a known history of difficult laryngoscopic intubation underwent laryngeal microsurgery for recurrence of a glottic tumour. As preoperative indirect laryngoscopy revealed a large, mobile, and pedunculated glottic lesion obstructing the glottic opening, we planned a conventional awake fibreoptic intubation. Endoscopy showed that the tumour partially obstructed the glottis and the space between the tumour and the glottic opening was very narrow. To avoid damage to the tumour, we changed to an alternative fibreoptic intubation technique. The FOB attached to a video camera was passed nasally and a jaw thrust manoeuver was applied, providing an excellent view of the larynx. An anesthesiologist inserted the ETT with a curved stylet orally, and carefully advanced the tube tip into the space between the tumour and the glottic opening under video control. Absence of damage to the tumour and passage of the tube between the cords were confirmed visually.

Conclusion: This alternative intubation technique, providing a view of the tube passage into the glottis, was a reasonable method to avoid potential damage to the glottic tumour by blind tube passage during conventional fibreoptic intubation.