Successful use of C-Mac video laryngoscope in a child with large parapharyngeal mass

An eleven-year-old child presented with a history of gradually increasing left side neck swelling and snoring for the last 6 years. He was initially scheduled for biopsy and on a second occasion for transcervical excision of left parapharyngeal mass under general anesthesia. Examination showed a left lateral pharyngeal and tonsillar mass compressing the oropharyngeal airway. CT neck showed a soft tissue mass (7 × 6 × 9 cm) in the left retropharyngeal space causing a bulge in the oropharynx with lateral deviation of carotid artery and internal jugular vein. During the first anesthesia for the biopsy, oral fiberoptic bronchoscopy (FOB), direct laryngoscopy, and Glidescope video laryngoscopy failed to visualize the glottis and epiglottis. After repeated attempts, intubation was possible with direct laryngoscopic-guided oral FOB. Fifteen days later, for the definitive surgery, the glottis was visualized at the first attempt using a C-Mac video laryngoscope and endotracheal intubation was successful at the first attempt after laryngeal manipulation. We discuss the potential causes of failure of intubation with the other airway devices in this child.