BACKGROUND: Acute epiglottitis is not uncommon and it can cause high mortality due to airway obstruction. Acute epiglottitis complicated with cervical necrotizing fasciitis has rarely been reported, and it is also a life-threatening disease with a fatality rate of 7% to 50%.
METHODS: A 64-year-old woman presented to our hospital with chief complaints of sore throat and cervical swelling, long with foreign body sensation and hoarseness. Endoscopic laryngoscopy showed erythematous and swollen epiglottis with purulent secretions on the surface. Computed tomography (CT) scan showed swollen epiglottis and swelling of the neck with air- and fluid-containing necrotizing tissue.
METHODS: The diagnosis was acute epiglottitis and abscess complicated with cervical necrotizing fasciitis.
METHODS: With the patient in awake condition, airway access was established by performing intubation with adjunctive use of gum elastic bougie, followed by surgical debridement under general anesthesia; a flap was used for skin coverage and intravenous piperacillin-tazobactam was administered.
RESULTS: The patient was discharged without complications.
CONCLUSIONS: Gum elastic bougie is a usable tool in difficult intubation. Adequate pre-anesthesia evaluation, patient sedation, and gentle manipulation assured the intubation success in this case.

Laryngeal air cyst (laryngocele) is a rare disease that is an abnormal cystic expansion of the deep structures of the laryngeal ventricle. They can be accompanied by serious complaints, such as shortness of breath, difficulty breathing during exercise, as well as at rest with large cysts. Computed tomography is the most effective method for determining the type, localization and degree of laryngocele. Although surgical treatment is considered the method of choice in cases of laryngeal air cyst, the approach significantly depends on the size of the lesion.
Воздушная киста гортани (ларингоцеле) — редкое заболевание, представляющее собой аномальное кистозное расширение глубоких структур гортанного желудочка. Симптоматика ларингоцеле вариабельна: от незначительных жалоб на дискомфорт при глотании и фонации, затруднение дыхания вплоть до одышки при физической нагрузке и/или в покое. В дополнение к визуализации гортани при эндоскопическом осмотре может быть использована компьютерная томография, которая является эффективным методом определения типа, локализации и степени ларингоцеле. Оперативное лечение — основной метод лечения данной патологии; способ хирургического подхода зависит от размера и локализации патологического процесса.

Difficult airway management poses a great challenge for clinicians, especially if it is unanticipated. Numerous guidelines and a wide array of devices constitute the anesthesiologist\'s armamentarium for managing the airway. When the use of individual devices fails, the use of combination techniques is advised. We present a case of difficult intubation in a 50-year-old male patient scheduled for aortic valve replacement. He had no prior history of difficult airway management, and no abnormalities were detected on preoperative airway assessment. Body mass index was 29 kg/m2. After the separate use of direct laryngoscopy, videolaryngoscopy and a BONFILS intubation endoscope (BIE) had failed, we resorted to a combination technique, combining videolaryngoscopy and BIE. While the videolaryngoscope provided the space needed for BIE and visual guidance through copious secretions, the BIE served as a stylet for endotracheal tube guidance, leading to successful intubation. Since the technique requires costly equipment, experience in handling it and at least two operators, it is more appropriate as a rescue measure than an elective procedure. Given the potentially disastrous outcomes of failed intubation, mastering advanced airway management techniques remains of vital importance, and the combination technique is one of them.

UNASSIGNED: One-lung ventilation is indicated during thoracic surgery for visualization and exposure of surgical site. It is achieved with bronchial blockers, double-lumen endobronchial tube, single-lumen endotracheal tubes and Univent tube for infants and children. Fibreoptic bronchoscope is required for placing and confirming the correct position of these tubes. We report a perioperative management of safe conduct of one lung ventilation for a 6-year child undergoing left lower lobe lobectomy through C-MAC video laryngoscope guided two single lumen tubes in limited resource settings where paediatric-sized fibreoptic bronchoscope is unavailable.

A vallecular cyst is a rare diagnosis in newborns presented with stridor, which poses a significant threat to the well-being of infants. This potentially life-threatening condition is associated with a range of complications, including respiratory distress, feeding difficulties, and failure to thrive. Through this case series, we aim to shed light on the suspicion of vallecular cysts in newborns presenting with stridor and the complexities encountered during their management, highlighting the importance of early recognition and intervention. We presented a case series consisting of three newborns who presented with stridor and respiratory distress symptoms to our center. All three cases were diagnosed using a flexible laryngoscope, and surgical intervention was done. The vallecular cyst was removed, and subsequent follow-up showed no recurrence of the lesion. This case series highlights the importance of early suspicion and recognition of vallecular cysts in newborns, emphasizing the thorough examination during diagnostic evaluations. Proper surgical planning and appropriate ventilation strategies are essential for the successful management and resolution of symptoms.

Vocal cord polyps are commonly encountered in the otorhinolaryngology department. The risk of anesthesia is high in patients with large vocal cord polyps. Awake intubation with appropriate airway tools provides a favorable safety profile.
We present the case of a 60-year-old male patient who had been suffering from a large vocal cord polyp for 16 years. Electronic laryngoscopy revealed that the vocal cord polyp was approximately 1.5 cm in diameter. The polyp had a pedicle and demonstrated synchronous motion with respiratory excursion. It covered almost the entire glottic area during inspiration and moved away from the glottis during expiration. A Disposcope endoscope was used for awake tracheal intubation, and the surgery was completed successfully.
The Disposcope endoscope can be a useful option for awake orotracheal intubation in cases of anticipated difficult intubation and difficult facemask ventilation.

We present a case of a preterm neonate with a type IV laryngo-tracheo-oesophageal cleft, an uncommon congenital malformation, resulting from the failure of separation of the trachea and the oesophagus during fetal development, often associated with other deformities as well. Data in the literature shows that the long-term morbidity from the entity has declined over the last decades, even though prognosis remains unfavourable for types III and IV. This report emphasizes the complex issues neonatologists are faced with, when treating neonates with this rare disorder in the first days of life, what will raise suspicion of this rare medical entity, and that direct laryngoscopy/bronchoscopy finally depicts the exact extension of the medical condition. At the same time extensive evaluation for coexisting congenital anomalies should be performed. For all the above reasons, these neonates should be treated in specialized tertiary pediatric centers for multidisciplinary prompt management, which may improve, the outcome.

BACKGROUND: Difficult intubation is the situation when a skilled anesthetist has difficulties to manage airway using face mask, laryngoscopy, supraglottic device, tracheal intubation, surgery. Videolaryngoscope and flexible fibroscope (FFS) represent valid alternatives for difficult airway management, with some limitations. However, literature lacks of studies about the efficacy of the combined use of videolaryngoscope and FFS.
METHODS: We report a case of a man, with glottic lesion, who needs surgery under general anesthesia. Anesthesiologic pre-operative evaluation revealed that he\'s a difficult intubation case. So, in a supine position, intubation was performed on first attempt by videolaryngoscope combined with FFS. On post-op, no signs of injuries due to intubation have been found.
CONCLUSIONS: In 2022, the American Society of Anesthesiologists defined the guidelines to manage difficult intubation: based on patient\' anatomical and clinical feature and anesthetist\' skills, several intubation procedures could be used. Each procedure has pros and cons.
CONCLUSIONS: It\'s the first case of anticipated difficult intubation in adult man that was intubated under general anesthesia by using videolaryngoscope combined with FFS. We demonstrated that this procedure is safe and useful in case of difficult airway and recommended in case of laryngeal lesions that hinder the visualization of glottic plane.

We previously reported that laryngeal widening led to improved exercise tolerance in COPD. However, it is not clear whether laryngeal narrowing occurs as a compensatory response to tracheal movement or is affected by posture. Here, we report the case of an advanced COPD patient whose more prolonged expiration in a head-forward leaning position compared with that in a neck-extended position occurred with an excessive duration of severe laryngeal narrowing without tracheal obstruction, which led to exercise intolerance with expiratory mechanical constraints. This case provided useful insights into the regulation of the upper airway with body positioning for improving exercise tolerance.

Arytenoid cartilage dislocation can occur as a complication of tracheal intubation and laryngeal trauma, but its occurrence with indirect video laryngoscopy has not been reported. This paper reports anterior arytenoid dislocation occurring after nasotracheal intubation performed under indirect laryngoscopy using a video laryngoscope (McGRATH MAC; Medtronic). The dislocation is presumed to have resulted from the laryngoscope blade being initially inserted too deeply and applying pressure to the posterior aspect of the left cricoarytenoid joint. This patient\'s anterior arytenoid dislocation was treated conservatively using speech therapy with resolution occurring approximately 40 days postoperatively. On the 74th day after surgery, fibroscopic examination confirmed recovery and healing of the dislocation. However, other types of arytenoid dislocations and laryngeal injuries may require alternative treatment. Early consultation with an otolaryngologist is recommended if arytenoid dislocation is suspected.