StyleTubation Applied for Difficult Airway With Post-Radiation Fibrosis and Halo-Vest Stabilization

Patients with nasopharyngeal cancer and following head/neck radiotherapy often experience a difficult airway during subsequent surgical treatment. Pre-operative airway examination usually reveals certain degrees of radiation-induced fibrosis over the neck, trismus, a higher Mallampati class, and an upper lip bite test grade. Available pre-operative transnasal videoendoscopic and radiological imaging findings might show vulnerable mucous membrane irregularities and anatomical abnormalities over the nasopharynx and larynx, and edematous or distorted epiglottis and vocal cords. Along with aforementioned adverse impacts, the need for mounting devices, such as halo-vest stabilization, would further restrict patients' cervical spines mobility and lead to more difficult endotracheal intubation. Both non-technical and technical skills, and various intubating tools/devices have been discussed in an evidence-based approach. Among them, videolaryngoscopy with/without flexible video-endoscopy is advocated for such difficult airway scenarios. In this short communication, we present our successful experience in applying StyleTubation (video intubating stylet technique) in such a difficult airway scenario (nasopharyngeal carcinoma patient, severe post-radiation fibrosis over the neck, mounted a halo-vest stabilization device, undergoing cervical spine surgery).