This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mahajan, R. Articles by Batra, Y.K. Search for Related Content PubMed PubMed Citation Articles by Mahajan, R. Articles by Batra, Y.K.

Submucous fibrosis secondary to chewing of quids: another cause of unanticipated difficult intubation

[Une fibrose sous-muqueuse secondaire à la mastication de tabac : une autre cause d'intubation difficile imprévue]

From the Department of Anaesthesia and Intensive Care Unit, Postgraduate Institute of Medical Education and Research (PGIMER ), Chandigarh, India.

Dr. Kajal Jain, Department of Anaesthesia and Intensive Care Unit, PGIMER, Chandigarh 160012, India. Phone: 747585 ext. 206; E-mail: dr_kajal{at}hotmail.com

Purpose: To report a case of unusual difficult intubation secondary to oral submucosal fibrosis (SMF) associated with malignancy of the hypopharynx.

Clinical features: A 57-yr-old male, ASA–I physical status presented for percutaneous nephrolithotripsy. The patient was a known alcoholic and smoker with a habit of chewing quids for the past 36 years. Airway assessment revealed oral SMF and slight difficulty in opening the mouth fully. Mentohyoid and mentothyroid distances were normal. However, during intubation, unanticipated difficulty was encountered. On direct laryngoscopy, the tip of the epiglottis could barely be visualized. Intubation was possible after passing a gum elastic bougie blindly under the epiglottis and negotiating a 7.0 internal diameter tracheal tube over it. Postoperatively, indirect laryngoscopy (IDL) showed severe SMF involving the oral cavity, epiglottis and pyriform fossae and an ulcerative malignancy of the hypopharynx with fixation of the left hemilarynx.

Conclusion: SMF is a premalignant condition of the oral cavity associated with fibrosis of involved structures that can be associated with malignancy of the aerodigestive tract. Distortion of the airway anatomy may render intubation difficult. IDL maybe useful in the preoperative evaluation of these patients.

This article has been cited by other articles:

				N. Eipe The Chewing of Betel Quid and Oral Submucous Fibrosis and Anesthesia Anesth. Analg., April 1, 2005; 100(4): 1210 - 1213. [Abstract] [Full Text] [PDF]