Lateral position for difficult intubation in a patient with history of hemiglossectomy and flap reconstruction: a case report.

ABSTRACT

BACKGROUND: Reconstructive head and neck surgery can alter upper airway anatomy. We report a difficult intubation in a patient with a history of hemiglossectomy and reconstruction. CASE PRESENTATION A 65-year-old female patient, who had undergone hemiglossectomy with the flap reconstruction, underwent video-assisted thoracoscopic esophagectomy for esophageal cancer. After the loss of consciousness during anesthesia induction, we failed to perform direct and oral fiberoptic intubation using a video laryngoscope and nasal fiberoptic intubation without or with video laryngoscope assistance in the supine position. Finally, shifting the patient to the left-lateral position allowed successful nasal fiberoptic intubation. Postoperatively, we were informed that she was unable to sleep in the supine position because of airway obstruction and therefore always slept on her side. CONCLUSION: Preanesthetic evaluation of the influence of body position on the airway patency during sleep or sedation may aid in airway management.