Failed Awake Flexible Intubation Followed by Early Surgical Tracheostomy in Advanced Laryngeal Cancer: A Case Report

Primary laryngeal cancers causing critical airway stenosis pose significant challenges to airway management. Although flexible bronchoscope guided awake intubation is generally recommended for anticipated difficult airways, the presence of a friable and obstructive mass may render this technique ineffective. We report the case of a 69-year-old male who presented with dyspnea and stridor due to a T4a transglottic carcinoma involving the vocal cords and anterior commissure. Despite a carefully planned awake flexible bronchoscopic intubation, advancement of the endotracheal tube was impossible due to the tumor's mass effect. Consequently, the airway management strategy was promptly changed to an emergency surgical tracheostomy under local anesthesia, which was successfully performed by an otolaryngologist on standby without perioperative complications. This case highlights the limitations of noninvasive techniques in the presence of severe anatomical distortion and emphasizes the importance of multidisciplinary preparation for immediate front-of-neck access in high-risk laryngeal cancer patients.