Akazawa Mai, Shimizu Morihiro, Fujino Yoshihisa, Kato Hiromi
Department of Comprehensive Surgery, Shiga University of Medical Science, Shiga, JPN.
Department of Anaesthesiology, Shiga University of Medical Science, Shiga, JPN.
Cureus. 2025 Feb 16;17(2):e79130. doi: 10.7759/cureus.79130. eCollection 2025 Feb.
Patients with head and neck cancer often experience airway complications. This case highlights a patient with nasopharyngeal cancer post-radiotherapy (RT), who presented with a difficult airway (DA). An 83-year-old woman, scheduled for a partial left lower lobe pneumonectomy, had received RT for nasopharyngeal cancer one year prior. Physical examination revealed trismus, limited neck movement, Mallampati class IV, and grade III on the upper lip bite test. Bronchoscopy showed mucous membrane irregularities in the nasopharynx, along with an edematous epiglottis and vocal cords. After general anesthesia induction, both mask ventilation and McGrath™ intubation (Covidien Inc., Tokyo, Japan) attempts failed. Lifting the patient's tongue manually allowed visualization of the vocal cords via a fiberoptic bronchoscope, enabling successful intubation. Patients who have undergone head and neck radiotherapy (HNRT) are at increased risk of DAs due to radiation-induced fibrosis (RIF) of pharyngeal soft tissues.
头颈癌患者常出现气道并发症。本病例突出了一名鼻咽癌放疗后患者，该患者出现了困难气道（DA）。一名83岁女性计划行左下肺叶部分切除术，一年前曾接受鼻咽癌放疗。体格检查发现牙关紧闭、颈部活动受限、Mallampati分级为IV级，上唇咬试验为III级。支气管镜检查显示鼻咽部黏膜不规则，会厌和声带有水肿。全身麻醉诱导后，面罩通气和使用麦格拉斯™喉镜（柯惠医疗公司，东京，日本）插管尝试均失败。手动抬起患者舌头后，通过纤维支气管镜可看到声带，从而成功插管。由于咽部软组织的放射性纤维化（RIF），接受过头颈放疗（HNRT）的患者发生困难气道的风险增加。
