Korean J Anesthesiol.  2006 Dec;51(6):742-745. 10.4097/kjae.2006.51.6.742.

Difficult Intubation due to Low Located and Right Deviated Thyroid Cartilage: A case report

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea. jychung@cu.ac.kr
  • 2Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, Korea.

Abstract

We report a case of difficult intubation due to a low located thyroid cartilage and a left deviated glottis abnormality. A 35-year-old woman was scheduled to undergo a laminectomy and discectomy for a L4-5 disc herniation. After injecting intravenous induction agents and muscle relaxant, intubation was attempted with a direct laryngoscope. However, no vocal cords were seen and only the epiglottis was seen albeit only slightly. According to Cormack and Lehane's grading, the patient was grade III. Although intubation was re-attempted after changing the anesthesiologist and device such as a light wand, the endotracheal tube could not be advanced below the epiglottis because of resistance. When patient was rechecked, her thyroid cartilage was located abnormally low and the thyromental distance was 14.5 cm. In addition, the preoperative chest X-ray revealed her airway to be deviated to the left. Intubation could be successfully performed after additional 100% oxygen mask ventilation. An otolaryngologic examination revealed that the glottic opening was deviated to the left, and ventricle of the larynx, which is normally not seen with a laryngocope was located to the center. It is believed that the reason for resistance of the advancing endotracheal tube was a centrally located ventricle of the larynx.

Keyword

difficult intubation; thyromental distance; ventricle of the larynx

MeSH Terms

Adult
Diskectomy
Epiglottis
Female
Glottis
Humans
Intubation*
Laminectomy
Laryngoscopes
Larynx
Masks
Oxygen
Thorax
Thyroid Cartilage*
Thyroid Gland*
Ventilation
Vocal Cords
Oxygen
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