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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

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Tonsillar lipoma causing difficult intubation: a case report.

Fevzi Sefa Dereköy¹, Hüseyin Fidan, Fatma Fidan

¹Department of Otolaryngology, Medicine Faculty of Afyon Kocatepe University, Afyon, Turkey. derekoy@aku.edu.tr

Kulak Burun Bogaz Ihtisas Dergisi : KBB = Journal of Ear, Nose, and Throat

|January 12, 2008

Summary

A large tonsillar lipoma caused severe breathing problems and difficult intubation in a patient with heart failure. Prompt surgical resection of the lipomatous mass resolved the respiratory distress.

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Area of Science:

Otolaryngology
Pulmonary Medicine
Pathology

Background:

A 63-year-old woman presented with confusion and severe hypoxemia.
The patient had a history of heart failure managed with diuretic therapy.

Observation:

Emergency intubation was challenging due to a previously unnoticed lateral pharyngeal mass.
The patient required emergency tracheotomy after accidental extubation.
Otolaryngological examination identified a mass originating from the right palatine tonsil.

Findings:

Computed tomography revealed a hypodense mass extending from the uvula to the epiglottis.
Surgical resection included a 3.6x3.2x2.2 cm lipomatous mass and the palatine tonsil.
Microscopic examination confirmed mature adipocytes consistent with a lipoma.

Implications:

Tonsillar masses, even if asymptomatic to the patient, can cause significant airway obstruction and intubation difficulties.
This case highlights the importance of thorough otolaryngological evaluation in patients with unexplained respiratory distress.
Lipomas of the palatine tonsil are rare but should be considered in the differential diagnosis of upper airway obstruction.