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.

Mucormycosis is a well-known yet complicated illness that seems benign but behaves malignantly. This article discusses the anesthesia challenges in providing care for a 49-year-old male who presented with post-Covid pneumonia and uncontrolled diabetes along with active mucormycosis and scheduled for functional endoscope sinus surgery (FESS) and debridement of necrotic tissue. We want to illustrate the importance of anticipated difficult airway, while highlighting the toxicity of intravenous amphotericin-B and its combination against anesthesia drugs.

Severe congenital neutropenia (SCN), commonly known as the Kostmann syndrome, is a rare and complex set of disorders defined by a lack of neutrophil maturation in the bone marrow, leading to life-threatening complications. This case report discusses a young adult patient scheduled for elective laparoscopic cholecystectomy. The patient presented with skin lesions which are a common scenario of Kostmann syndrome, but along with that, our patient posed challenges of short neck, limited neck extension, and gynecomastia. These additional conditions dramatically increased the challenges for anesthesiologists to address the anticipated difficult airway. The anticipated difficult airway challenges were handled by following the protocols of difficult airway guidelines 2022.

Lingual thyroglossal duct cysts can be a rare cause of feeding difficulties in infants. Here, we describe a case of an infant with vomiting and feeding difficulty diagnosed with Hirschsprung\'s disease. However, she developed an unexpected difficult airway during anesthesia induction due to an undiagnosed lingual thyroglossal duct cyst.

OBJECTIVE: Intubation and ventilation cannot be performed in cases of parapharyngeal space tumors as the enlargement of the upper airway leads to the obstruction and hindrance of the intubation procedure. However, there is limited literature on anesthetic management, including the airway, in this disease. Herein, we report a successful case of awake intubation in a patient with parapharyngeal space tumor.
METHODS: A 64-year-old man with a history of giant parapharyngeal space tumor was scheduled for bilateral endoscopic sinus surgery and nasal septoplasty. We performed awake intubation using the McGrath® video laryngoscope, which resulted in excellent laryngeal deployment and a smooth procedure.
CONCLUSIONS: We report the anesthetic management of a giant parapharyngeal space tumor with the potential for difficult airway management to maintain spontaneous breathing. Awake intubation was useful in maintaining ventilation and intubation in this case. The preparation of a cricothyroid puncture is needed in cases of intubation failure.

Double-lumen intubation is commonly used for thoracic surgery as it allows rapid and effective one-lung ventilation. However, it is more difficult than single-lumen tube intubation, notably in the context of emergency surgery and/or in hypoxemic patients. We report the case of a 57-year-old patient requiring emergency revision surgery after an upper right lobectomy due to postoperative pneumothorax and pleuropneumonia. As rapid lung isolation was required due to a bronchopleural fistula, rapid sequence induction and double-lumen tube intubation were performed. In addition, as the patient was hypoxemic with incomplete pre-oxygenation and too uncomfortable to tolerate the recumbent position despite high-flow oxygen, intubation was performed in face-to-face position. The patient was successfully intubated in 22 seconds and the right lung immediately isolated, allowing the surgeon to clean the pleural cavity. This is the first report of a double-lumen tube intubation in face-to-face position. The expected difficulties related to this type of intubation were successfully prevented using an Airtraq laryngoscope. Although such a strategy cannot be recommended from this one case, this report is encouraging for future studies evaluating the potential advantages of Airtraq use for double-lumen face-to-face intubation for emergency thoracic surgery.

We report a case of unexpectedly difficult intubation in a patient with a huge but asymptomatic choanal polyp. A 77-year-old man with invasive bladder cancer was scheduled for total cystectomy under general anesthesia. However, tracheal intubation with a Macintosh laryngoscope proved impossible due to obstruction by a large oropharyngeal tumor. Using a video laryngoscope, intubation was successfully achieved. Choanal polyps are not uncommon, but large choanal polyps reaching the oropharynx appear relatively rare. Anesthesia and airway management for large oropharyngeal tumor has not been sufficiently discussed.

OBJECTIVE: Pentax airway scope (AWS) has been successfully used for managing difficult intubations. In this case series, we aimed to evaluate the success rate and time taken to complete intubation, when AWS was used for awake tracheal intubation.
METHODS: We prospectively evaluated the use of AWS for awake tracheal intubation in 30 patients. Indication for awake intubation, intubation time, total time to complete tracheal intubation, laryngoscopic view (Cormack and Lehane grade), total dose of local anaesthetic used, anaesthetists rating and patient\'s tolerance of the procedure were recorded.
RESULTS: The procedure was successful in 25 out of the 30 patients (83%). The mean (standard deviation) intubation time and total time to complete the tracheal intubation was 5.4 (2.4) and 13.9 (3.7) min, respectively in successful cases. The laryngeal view was grade 1 in 24 and grade 2 in one of 25 successful intubations. In three out of the five patients where the AWS failed, awake tracheal intubation was successfully completed with the assistance of flexible fibre optic scope (FOS).
CONCLUSIONS: Awake tracheal intubation using AWS was successful in 83% of patients. Success rate can be further improved using a combination of AWS and FOS. Anaesthesiologists who do not routinely use FOS may find AWS easier to use for awake tracheal intubation using an oral route.

There are many problems in the anesthetic management of patients with scar contracture. In this case, a 41-year-old male with severe scar contracture on his face, neck, anterior chest, and both shoulders underwent surgery for resurfacing with flaps. We tried to awake fiberoptic orotracheal intubation with GlideScope® Video laryngoscope guide after surgical release of contracture under local anesthesia. We report a successful management of a patient with severe burn contracture achieved by combined effort of surgeons and anesthesiologists.