TY  - CHAP
M1  - Book, Section
TI  - Chapter 37. Airway Management of a Patient with an Unanticipated Difficult Laryngoscopy (Lingual Tonsillar Hypertrophy)
A1  - Crosby, Edward
A2  - Hung, Orlando
A2  - Murphy, Michael F.
PY  - 2012
T2  - Management of the Difficult and Failed Airway, 2e
AB  - An  obese,  diabetic  57-year-old  woman  presented  for  femorotibial  bypass  with  vein  and  graft.  Despite  a  recommendation  in  favor,  she  refused  regional  anesthesia.  A  general  anesthetic  with  endotracheal  intubation  due  to  the  prolonged  nature  of  the  operation  was  planned.  Following  induction  of  general  anesthesia,  bag-mask-ventilation  (BMV)  was  difficult  and  an  immediate  attempt  at  direct  laryngoscopy  was  made.  An  obstructing  soft  tissue  mass  in  the  vallecula  at  the  base  of  the  tongue  was  observed  with  the  direct  laryngoscope;  tracheal  intubation  was  impossible  with  both  direct  laryngoscopy  and  with  a  lighted  stylet  and  some  bleeding  was  observed  after  several  attempts  at  intubation.  A  size  3  laryngeal  mask  airway  (LMA)  was  placed,  adequate  ventilation  was  achieved,  the  procedure  was  abandoned,  and  the  patient  was  awakened  and  taken  to  the  recovery  room.  Following  the  procedure,  the  patient  was  referred  to  an  otolaryngologist,  and  nasolaryngoscopy  revealed  lingual  tonsillar  hypertrophy  (LTH).  The  lingual  tonsil  was  observed  to  be  occupying  and  filling  the  vallecula  and  obstructing  the  view  of  both  the  epiglottis  and  the  laryngeal  inlet.  Because  she  derived  no  symptoms  from  the  lesion,  surgical  excision  was  not  felt  to  be  indicated  and  she  was  referred  back  to  her  vascular  surgeon.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=55871038
ER  -