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Chapter 36. Airway Management of a Patient with a History of Oral and Cervical Radiation Therapy

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Which of the following is NOT true in the airway management of a patient with a history of radiotherapy to the head and neck?

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A. surgical airway should be uncomplicated

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B. limited mouth opening may preclude rigid fiberoptic intubating techniques

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C. fibrosis of the structures of the floor of the mouth can make direct laryngoscopy difficult

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D. a decrease in vocal cord mobility may interfere with glottic cannulation

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E. in the presence of anatomic distortion of the airway, the light-guided technique using a lightwand is best avoided

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(A) Radiotherapy to the head and neck can produce limited mouth opening, limited cervical spine extension, noncompliant fibrotic soft tissue in the floor of the mouth and pharynx, and alteration of laryngeal anatomy. All airway management techniques, including the surgical airway, can be difficult.

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The most significant clinical predictor of impossible mask-ventilation is:

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A. neck radiation changes

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B. obesity

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C. obstructive sleep apnea

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D. presence of a beard

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E. male sex

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(A) Neck radiation changes.

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Anatomic and pathophysiologic changes associated with head and neck radiotherapy include:

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A. edema

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B. fibrosis

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C. trismus

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D. xerostomia

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E. all of the above

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(E) All of the above.

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