Radiation-Induced Airway Distortion Complicating Endotracheal Intubation: A Case Report

Airway management in patients with a history of head and neck radiotherapy presents significant challenges due to radiation-induced fibrosis, anatomic distortion, and friable tissues. These changes increase the risk of difficult mask ventilation, failed intubation, and airway trauma. We present the case of a 77-year-old male with a history of oropharyngeal squamous cell carcinoma treated with chemoradiation who required general anesthesia for jejunostomy tube placement. Preoperative evaluation suggested a potentially difficult airway. Video laryngoscopy revealed a severely distorted and edematous glottic opening surrounded by friable neoplastic tissue, complicated by significant bleeding during intubation. A stepwise airway strategy utilizing video laryngoscopy, aggressive suctioning, and close multidisciplinary coordination resulted in successful endotracheal intubation and an uneventful postoperative course. This case highlights the importance of early airway assessment, careful planning, and the use of advanced airway techniques in patients with prior head and neck radiotherapy.