Abstract
We herein report a case of unavoidable emergency tracheotomy which occurred during a preoperative examination due to difficulty of intubation that we were unable to predict. The patient was a 70-year-old male diagnosed with carcinoma of the floor of the oral cavity and scheduled for tumor resection and reconstruction with an abdominal full-thickness skin flap graft under general anesthesia. After gentle and passive induction with N2O+oxygen+sevoflurane, the larynx was exposed and nasal intubation was attempted. However, it was impossible to insert the tube beyond the vocal cords and bronchofibroscopy revealed thickening of the vocal folds. It was concluded that it is impossible to insert the tube and an emergency tracheotomy was necessitated. There were no ventilatory problems after the tracheotomy and no abnormal respiratory tract manifestations were observed intraoperatively. Postoperatively, a tracheal cannula was used for respiratory management and when decrease of vocal fold thickening was confirmed, the patient was extubated. There is a wide spectrum of causes in difficulty in intubation of endotracheal tubes and there are occasions where it is difficult to predict such episodes. Reinke's edema attributable to chronic smoking was suspected in our patient and this case was informative to clinicians of the importance of a rapid and appropriate response to unpredictable situations and episodes.
