Abnormally anterior palatoglossal arches: implications for laryngoscopy and tracheal intubation

Abstract

A 26-year-old man was listed for excision of a vestibular schwannoma. Abnormally anterior palatoglossal arches were noted during pre-operative anaesthetic evaluation (Fig. 1). The palatoglossal arches are ridges created by the palatoglossus muscles, one of the four pairs of extrinsic muscles of the tongue [1]. Rarely, the attachment of palatoglossus muscles can be so anterior that it might make displacement of the tongue challenging during laryngoscopy [2].In the absence of other risk factors for difficult airway management, and considering the risk of raised intracranial pressure with awake tracheal intubation, we planned for tracheal intubation under general anaesthesia.Following induction of general anaesthesia with fentanyl 150 lg and propofol 180 mg, facemask ventilation was straightforward. Direct laryngoscopy was performed with a size 4 Macintosh blade: the tongue was displaced from right to left Figure 1 Abnormally anterior palatoglossal arches within the patient's oral cavity.