Microlaryngoscopy for benign vocal cord lesion excision is a procedure with good outcomes and relatively few complications that is performed worldwide. The anterior one-third of the vocal cords is a relatively common site to find benign polyps, and the excision of cases with adequate laryngeal exposure is relatively easy. However, they can sometimes present a challenge when laryngeal exposure is suboptimal, which leads to trouble in accessing the site. The factors that can lead to difficulties in laryngeal exposure are numerous, such as restricted mouth opening, limited neck extension, large tongue size, and others. The preoperative prediction of difficult laryngeal exposure (DLE) can be obtained by different scoring and grading systems. We have used the Laryngoscore in this case. However, management options for such cases remain limited. Here, we present a case that was managed using channeled cup forceps under fiberoptic endoscopy with the STRIVE-Hi technique used to administer anesthesia.
Studies have demonstrated that poor assessment and planning contribute to airway complications and that current airway assessment strategies have a poor diagnostic accuracy in predicting difficult intubation in the general population. There is a higher risk for difficulties during airway management in patients with pathologies arising from the head and neck region and are more likely to need emergency surgical access. Therefore, thorough assessment and adequate knowledge about the various head and neck pathologies is mandatory. In this chapter, we will briefly go through the preoperative assessment and history & clinical assessment, the investigations. Also we will discuss the airway management at various pathologies involving the head and neck region whether benign/malignant pathologies, OSA (obstructive sleep apnea) and post head & neck operative airway management.
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