[Use of intubating laryngeal mask airway in combination with fiberoptic intubation in a patient with morbid obesity and unexpected lingual tonsillar hypertrophy].

Lingual tonsillar hyperplasia is rare, but may cause difficult or impossible tracheal intubation. We administered anesthesia to a female patient with a body mass index (BMI) of 47 kg x m(-2) with unexpected lingual tonsillar hyperplasia. A 32-year-old woman was scheduled for surgery to repair a ventral hernia under general anesthesia. After inducting anesthesia, three anesthesiologists were needed to ventilate via a facemask. At direct laryngoscopy, after achieving muscular relaxation, the arytenoids and epiglottis could not be identified because of markedly hypertrophied tissue. Next, we attempted to use Trachlight for tracheal intubation, but no light was seen through the anterior region of the neck. After inserting a laryngeal airway mask (LMA), ventilation could be continued. We replaced the LMA with an intubating laryngeal mask airway (ILMA) for the purpose of tracheal intubation. Finally, the patient's trachea was intubated by ILMA with fiberoptic bronchoscopy. Several methods for tracheal intubation for the patients with lingual tonsillar hypertrophy have been reported; the insertion of an ILMA might be considered for safe airway management in combination with a fiberscope.