Submucous fibrosis secondary to chewing of quids: Another cause of unanticipated difficult intubation

Abstract

Purpose: To report a case of unusual difficult intubation secondary to oral submucosal fibrosis (SMF) associated with malignancy of the hypopharynx.Clinical features: A 57-yr-old male, ASA-I physical status presented for percutaneous nephrolithotripsy. The patient was a known alcoholic and smoker with a habit of chewing quids for the past 36 years. Airway assessment revealed oral SMF and slight difficulty in opening the mouth fully. Mentohyoid and mentothyroid distances were normal. However, during intubation, unanticipated difficulty was encountered. On direct laryngoscopy, the tip of the epiglottis could barely be visualized. Intubation was possible after passing a gum elastic bougie blindly under the epiglottis and negotiating a 7.0 internal diameter tracheal tube over it. Postoperatively, indirect laryngoscopy (IDL) showed severe SMF involving the oral cavity, epiglottis and pyriform fossae and an ulcerative malignancy of the hypopharynx with fixation of the left hemilarynx.Conclusion: SMF is a premalignant condition of the oral cavity associated with fibrosis of involved structures that can be associated with malignancy of the aerodigestive tract. Distortion of the airway anatomy may render intubation difficult. IDL maybe useful in the preoperative evaluation of these patients.

Lung Isolation in a Patient with Sub Mucosal Fibrosis: Anaesthesiologist Perspective

“…Oral Sub mucosal fibrosis (OSMF) is a chronic condition, involving the oral cavity sometimes even the pharynx and is associated with decreased mouth opening [2,3]. It is an inflammation, which occurs in the sub mucosal region, leading on to fibrosis and decreasing the supple nature of oral mucosa.…”

A Case Report of Patient With Oral Submucous Fibrosis

“…The mixture is held adjacent to the buccal mucosa and slowly chewed over a long period of time. It produces effects similar to those of smoking tobacco and is addictive 7 . OSMF typically affects the buccal mucosa, lips, retromolar areas, soft palate and occasionally the pharynx and the esophagus.…”

Betel quid, chewing habits and difficult intubation: A case report and critical appraisal of evidence for practice

“…[ 3 ] Unanticipated difficult intubation (case 2), is reported with submucus fibrosis involving epiglottis and fixation of left hemilarynx. [ 6 ] Preoperative indirect laryngoscopy has been suggested, but history of chewing habit is important to undertake this. Eipe has reviewed anesthetics of 44 patients with oral malignancies, and 8 had OSF.…”