[Application of video laryngoscope for vocal cord synechiotomy in a patient with recurrent laryngeal nerve paralysis].

Vocal cord synechia causes respiratory disturbance and severe pneumonia. A 63-year-old woman with recurrent laryngeal nerve paralysis caused by translaryngeal intubation after resection of acoustic tumor and by thyroid surgery in her history and progressive dyspnea, had received vocal cord synechiotomy under general anesthesia. Preoperative endoscopic examination revealed edematous larynx, immobility of left unilateral vocal fold, insufficient mobility of right vocal fold, left arytenoid cartilage dislocation and a posterior glottic adhesion. Anesthesia was induced by propofol administration, and a muscle relaxant was administered following confirmation of effective face mask ventilation. Trachea was cannulated immediately after incision of the scar under indirect video laryngoscopy. Vocal cord synechiotomy was completed without any respiratory complication. The case indicated that recurrent laryngeal nerve paralysis has a potential for vocal cord synechia and difficulty of tracheal intubation, and visibility of the surgical field among anesthesiologists and surgeons by indirect video laryngoscopy for vocal cord synechiotomy contributes to establish prompt surgical manipulation and tracheal intubation as to vocal cord synechiotomy.

Tracheal intubation in a patient with undetectable tracheal narrowing on chest radiography.

We report here a 59-year-old man with a saber-sheath tracheal narrowing who was scheduled to undergo pharyngeal tumor resection under general anesthesia. The tracheal narrowing was not clearly detected by chest radiography during the preoperative examination, but it was visible on axial computed tomography (CT) images taken earlier for diagnostic purposes. Following fiber optic examination of the narrowed segment with the patient under anesthesia, the tube was inserted into the trachea using an Airway Scope. The tube was deliberately advanced into the trachea and was able to pass through the stenosis without any resistance. On postoperative radiological analysis, three-dimensional reconstruction of the trachea and virtual bronchoscopic images revealed a saber-sheath type tracheomalacia located from below the cricoid cartilage to the carina. The membranous wall had a normal width. This case indicates that chest radiographs may occasionally be inadequate for evaluating asymptomatic patients with tracheomalacia. If CT images have been taken for diagnostic purposes, they should be examined together with the chest radiograph. Digital chest radiography with edge enhancement may become a useful tool in the preoperative detection and evaluation of undetectable tracheal narrowing on conventional chest films.