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[Hyperplasia of the lingual tonsil as an unexpected intubation obstruction in a preschool child]
1Abtellung für Anästhesiologie, Universitäts-Krankenhaus Eppendorf, Hamburg.
Insights
A five-year-old boy experienced difficult airway management during elective surgery due to undiagnosed lingual tonsillar hyperplasia. This case highlights the critical need for preoperative pharyngeal inspection before endotracheal intubation.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Otolaryngology
Background:
- A five-year-old boy with developmental delays and suspected muscular weakness underwent elective squint surgery.
- Previous tonsillectomy and adenotomy were performed six months prior to admission.
Observation:
- Preoperative pharyngeal inspection was omitted due to the child's uncooperativeness.
- Massive lingual tonsillar hyperplasia precluded endotracheal intubation during anesthesia induction.
- A laryngeal mask was successfully used for airway management.
Findings:
- Undiagnosed lingual tonsillar hyperplasia can lead to unexpected difficult airway management in pediatric patients.
- Laryngeal mask airway (LMA) can be a viable alternative when endotracheal intubation is impossible.
Implications:
- Emphasizes the importance of thorough preoperative airway assessment, including pharyngeal inspection, even in elective pediatric cases.
- Suggests that LMAs can be crucial tools for managing difficult airways in children when endotracheal intubation fails.
Abstract:
Case report of a five year-old boy who was admitted for elective squint surgery. The medical history revealed some delay in his behavioural and mental development as well as an unspecific dysmorphic syndrome with suspected muscular weakness. Tonsillectomy and adenotomy have been performed six months prior to admission. During examination on the day before surgery, the child presented only mild symptoms of a subsiding upper respiratory infection. Because of the uncooperativeness of the child the pharyngeal inspection was not performed. On the day of surgery total intravenous anaesthesia was induced by injection of sufentanil, propofol and atracurium. Ventilation with 100% oxygen via facemask was uneventful. However, laryngoscopy for endotracheal intubation was impossible due to a massive lingual tonsillar hyperplasia. A size 2 laryngeal mask with flexible spiral-tubing was inserted and anaesthesia was maintained using continuous propofol infusion. The surgical procedure was finished after 30 min and the laryngeal mask was removed. The following postoperative course was uneventful and the child was discharged from the hospital two days later. The present case report demonstrates the importance of preoperative pharyngeal inspection prior to elective endotracheal intubation and the possibility of unexpected difficult airway management by the laryngeal mask.