Folding of the epiglottis - an unusual complication to be recognized after laryngoscopic endotracheal intubation

We report a case of folding of the epiglottis during endotracheal intubation, an unusual complication of intubation. A 36-year-old female patient underwent laryngeal microsurgery for a vocal polyp. Following anesthesia induction, an endotracheal tube (ID = 6.0 mm, cuffed) was advanced through an intubating laryngoscope via the oropharyngeal route. At the beginning of the surgery, the otolaryngologist noted that the patient's epiglottis was folded under the view of the surgical laryngoscopy. The endotracheal tube was adjusted immediately by withdrawing it 0.5 cm with the cuff deflated. Slight edema of the upper ridge of the epiglottis was noted. There were no sequelae such as laryngeal spasm or vocal cord palsy after the surgery. The "peardrop" phenomenon is suggested as a possible cause of this event. Potential adverse outcomes of this unusual occurrence are reviewed.