Department of Anesthesiology, The First Affiliated Hospital of Zhejiang University, Zhejiang, China.
Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
J Int Med Res. 2020 Nov;48(11):300060520971498. doi: 10.1177/0300060520971498.
Tracheobronchopathia osteochondroplastica (TO) is a rare disease that may cause unexpected difficult intubation. There is no available consensus on the management of difficult intubation that is associated with TO. A 45-year-old woman was scheduled for modified radical mastoidectomy, canaloplasty, and tympanoplasty under general anesthesia. We encountered significant resistance during tracheal intubation, although the laryngeal view was normal with the video laryngoscope. A fiberoptic bronchoscope was then used to facilitate intubation, and we noted that the trachea was obviously narrowed due to cartilaginous ring hypertrophy. The tracheal tube was fully lubricated with tetracaine gel, and smoothly inserted into the trachea. After the operation, bronchoscopy and a computed tomography (CT) scan were performed to confirm the diagnosis of TO. Fiberoptic bronchoscopy-assisted tracheal intubation is safe and effective choice for the patients in whom subglottic intubation is difficult. CT scan and bronchoscopy might be helpful for preoperative airway assessment. Identifying patients with TO is important to avoid unexpected tracheal intubation impediment. Assessment of the subglottic airway should also be taken seriously.
气道骨软骨病（TO）是一种罕见的疾病，可能导致意外的插管困难。目前对于与 TO 相关的困难插管管理尚无共识。一名 45 岁女性拟在全身麻醉下行改良乳突根治术、鼓室成形术和乳突切开术。尽管视频喉镜下喉视图正常，但我们在气管插管时遇到了明显的阻力。然后使用纤维支气管镜辅助插管，我们注意到气管明显狭窄，是由于软骨环增生所致。充分润滑气管导管的四卡因凝胶，然后顺利插入气管。术后行支气管镜和 CT 扫描以确诊 TO。对于声门下插管困难的患者，纤维支气管镜辅助插管是一种安全有效的选择。CT 扫描和支气管镜检查有助于术前气道评估。识别 TO 患者对于避免意外的气管插管困难很重要。应重视对声门下气道的评估。
