Giant Neck Mass in a Patient with Mallampati Classification 3- Anaesthetic Management.

ABSTRACT

The American Society of Anesthesiologists (ASA) task force defined a difficult airway as “a clinical situation in which a conventionally trained anaesthesiologist experiences difficulty with mask ventilation, difficulty with tracheal intubation, or both”.[1] The task force further noted that the “difficult airway" represented a complex interaction between patient factors, the clinical setting, and the skills and preferences of the practitioner. Lipomas are slow-growing benign soft-tissue tumours which are typically asymptomatic. Giant lipomas in the cervical region of neck are rare. A lipoma is considered to be of excessive size when it exceeds 10 cm in length in any dimension or weighs over 1000 g. During induction of anaesthesia, a huge mass on the back of neck which does not allow the patient to lie supine is a risk factor for difficult airway.[2,3,4]Proper positioning is pertinent for induction of anaesthesia, securing the airway and surgical accessibility. In patients with anticipated difficult airway, fiberoptic intubation under spontaneous ventilation has been considered an effective and safe choice, taking into account that laryngoscopic intubation may worsen any difficult airway scenario.[5] We report a case of huge lipoma over the back of neck that limits neck movements in a patient having mouth opening of one finger due to chronic tobacco chewing.A mass on upper back which limits positioning of the patient supine for induction of anaesthesia is a challenge for anaesthesiologists for the management of airway. Complications due to airway manipulation are one of the commonest causes for anaesthesia related morbidities and mortalities. We report the anaesthetic management of a 55 year old male patient, having mouth opening of one finger due to chronic tobacco chewing, protruding teeth in upper jaw and missing teeth in lower jaw scheduled for resection of a giant mass (huge lipoma), over the upper back that restricted flexion and extension movement of the neck. We selected awake fibreoptic bronchoscopy assisted endotracheal intubation as a safe approach in this difficult airway scenario.