title: [An Adult Case of Difficult Intubation Caused by Late Complications of Radiotherapy for Pediatric Neck Malignancy, as well as a Later Laryngeal Elevation Surgery].
abstract: We present a case of a 32-year-old female who underwent endoscopic sinus surgery under general anesthesia. She had been diagnosed as rhabdomyosarcoma of her neck at 5 years of age, and received tumor resection and chemoradiotherapy. Afterwards, she was suffering from dysphagia as a late complication of radiotherapy. She received laryngeal elevation surgery at 24 years of age, in order to improve swallowing disturbance. With rapid induction of anesthesia, she was easily ventilated with mask and bag. However, it was difficult to visualize her vocal cord with various intubating apparatus, because of her mandible hypoplasia, small oral cavity, and laryngeal elevation. After all, we were able to intubate her trachea using Pentax Airway-scope® (AWS) with a Pediatric-type INTLOCK Blade™ (ITL-P). Radiotherapy for head and neck malignancy at childhood causes various late complications, leading to difficult intubation. Meanwhile, laryngeal elevation surgery for dysphagia anatomically makes intubation more difficult An adult who has such past history should be expected as an extremely difficult intubation case, and we must be prepared with various intubating apparatus including AWS with ITL-P.
authors.forename: Mari
authors.initials: M
authors.lastname: Sunohara
authors.forename: Toshiki
authors.initials: T
authors.lastname: Okada
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D007818:Laryngeal Diseases / Q000209:etiology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D011878:Radiotherapy / Q000009:adverse effects; D013997:Time Factors