Successful Airway Management Using Awake Videolaryngoscopy for a Rare Thyroid Cancer with Grade III Goitre and Intra-Tracheal Invasion

Abstract

In the present report, we described a case of anticipated difficult intubation in which the access to airway was limited due to external and internal factors. Our patient presented with a large goitre, shortness of breath and mild stridor. A clinical examination and investigations were performed. An intra-tracheal subglottic mass visible on a positron emission tomography scan was nearly occluding the lumen. The clinical diagnosis was thyroid cancer with intra-tracheal invasion. For patients with a large thyroid cancer, airway management can be complicated, using both regional invasion and intrathoracic extension, due to the effect of the mass on the airway and major vessels. This approach has a great potential for leading to complete airway obstruction after the induction of general anaesthesia. Here, we aimed to discuss the meticulous planning and preparation for the intubation of a conscious patient using different procedures of airway management, especially when the fibreoptic intubation failed and awake videolaryngoscopy salvaged the situation.

Keywords: Airway; awake; goitre; thyroid cancer; videolaryngoscopy.

Figure 1

Large goitre in the supine position

Figure 2

Positron emission tomography scan showing a large anterior neck mass extending from the infrahyoid to the thoracic inlet

Figure 3

Another view of a positron emission tomography scan showing tracheal invasion by thyroid cancer and occupying 80% of the lumen

Figure 4

Summary of the preparation for the local anaesthesia of airway