Orofacial or neck surgery can cause airway deformation or abnormal positioning, potentially leading to intubation difficulties. We treated a patient with a history of having undergone a thyroidectomy. Because of the absence of any factors suggesting the possibility of airway difficulty, we chose to perform intubation using a laryngoscope, as usual. During intubation, however, the tracheal tube could not be advanced after passing through the glottis. Fiberscopy showed that the tip of the tube had become stuck on an inner protrusion of the repaired granulated tissue. Therefore, the tube was subsequently inserted while avoiding the border under a fiberscopic view.
For patients with a history of surgery in the neck region, a detailed examination such as computed tomography may be required in addition to careful palpation and inspection. When abnormalities of the trachea are predicted, intubation under fiberscopic guidance or video laryngoscopy might be useful for reducing complications such as tracheal injury.
