Radiation-Induced Nasopharyngeal Fibrosis Resulting in a Difficult Airway: A Case Report

Patients with head and neck cancer often experience airway complications. This case highlights a patient with nasopharyngeal cancer post-radiotherapy (RT), who presented with a difficult airway (DA). An 83-year-old woman, scheduled for a partial left lower lobe pneumonectomy, had received RT for nasopharyngeal cancer one year prior. Physical examination revealed trismus, limited neck movement, Mallampati class IV, and grade III on the upper lip bite test. Bronchoscopy showed mucous membrane irregularities in the nasopharynx, along with an edematous epiglottis and vocal cords. After general anesthesia induction, both mask ventilation and McGrath™ intubation (Covidien Inc., Tokyo, Japan) attempts failed. Lifting the patient's tongue manually allowed visualization of the vocal cords via a fiberoptic bronchoscope, enabling successful intubation. Patients who have undergone head and neck radiotherapy (HNRT) are at increased risk of DAs due to radiation-induced fibrosis (RIF) of pharyngeal soft tissues.