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Case Reports
. 2024 Nov 6;16(11):e73164.
doi: 10.7759/cureus.73164. eCollection 2024 Nov.

Blind Nasotracheal Intubation in a Patient With Ankylosing Spondylitis and Severe Cervical Spine Deformities: A Case Report on Challenges and Approaches to Difficult Airway Management

Affiliations
Case Reports

Blind Nasotracheal Intubation in a Patient With Ankylosing Spondylitis and Severe Cervical Spine Deformities: A Case Report on Challenges and Approaches to Difficult Airway Management

Nebojsa Brezic et al. Cureus. .

Abstract

Airway management in patients with advanced ankylosing spondylitis (AS) presents a unique challenge due to possible cervical spine deformities that restrict neck mobility and affect access to the airway. Traditional airway management strategies, such as direct laryngoscopy and even fiberoptic intubation, are often rendered ineffective due to these anatomical limitations. Furthermore, surgical options like tracheostomy can be infeasible in cases with significant neck deformities, necessitating alternative approaches. This case depicts a 48-year-old male with untreated AS who presented to the emergency department following a fall, resulting in unstable vertebral fractures and paraplegia. The patient's severe cervical deformities posed significant challenges to airway management, and conventional airway management strategies, including fiberoptic intubation, were unsuccessful. Given the impracticality of tracheostomy due to the anatomical limitations, blind nasal intubation was successfully performed in a semi-recumbent position. This case underscores the complexities of airway management in AS patients with severe deformities. It highlights the importance of alternative intubation strategies, even blind nasotracheal intubation, when conventional methods fail due to anatomical constraints.

Keywords: ankylosing spondylitis; blind nasotracheal intubation; cervical spine deformities; difficult airway management; intubation challenges.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. A 3D reconstruction of a CT scan revealing pronounced cervical deformities, characterized by severe hyperkyphosis and ankylosis (indicated by the white arrow), along with a spinal fracture (denoted by the black arrow).
CT - computerized tomography
Figure 2
Figure 2. Severe cervical spine hyperkyphosis presenting as ''chin-on-chest'' deformity on (A) side and (B) front views.

References

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