[A difficult intubation in a case of endolaryngeal paraganglioma]

In a female patient aged 71, a tumor of unknown histology almost completely occupied the whole of the supraglottic space. Because of the valve-like behaviour of the tumor, the patient could not be ventilated by mask. Therefore, preoxygenation and preservation of spontaneous breathing were essential. Anaesthesia was induced by titration of etomidate, and no muscle relaxant or opioid was administered. The patient was successfully intubated by means of direct laryngoscopy. In all probability the blind nasal technique or the use of a fiberoptic device would not have been helpful, because the tumor had to be luxated before the endotracheal tube could be placed. Figure 1 shows the tumor (a) with a diameter of approximately 3 cm, which has displaced the epiglottis (b) to the left. A part of the endotracheal tube is visible at the bottom left. The spiral tube had to be replaced by a tube suitable for laser surgery. After resection (see Fig. 2) the coagulated tumor base (a) and the right vocal cord (b) can be seen with the laser tube still in place. Postoperatively extubation was possible. The histological examination revealed a paraganglioma without signs of malignancy. Apart from occlusion of the upper airway, the main danger stems from the considerable vascularization of such a paraganglioma. Not only the surgical procedure, but also minor manipulations during the endotracheal intubation may cause significant blood loss. In a small percentage of cases hormone-mediated cardiocirculatory complications may occur. If a difficult intubation is expected because of an endolaryngeal tumor, management should be based on the diagnostic findings and the planned surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)