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Abstract

Parotid abscess originates from an ascending infection of the parotid gland through Stensen’s duct, which progresses into formation of pus. Infections involving the oral or neck structure may obscure the vocal cords and complicate the tracheal intubation with direct laryngoscopy. We present a case of 44-year-old male patient presented with painful swelling of the left cheek extending into the temporal region for four days. His physical examination revealed erythematous swelling of the left cheek that limited the patient’s mouth opening. He was diagnosed with left-sided parotid abscess and surgical drainage was planned. The hyoid-mental and thyrohyoid distances were decreased, which indicated that the patient’s airway might be difficult to visualize with direct laryngoscopy. We decided to choose awake intubation with flexible intubation scope for tracheal tube placement. The procedure went smoothly without any complication and the patient’s condition was stable throughout 18 days of care in the intermediate ward. The current gold standard management of anticipated difficult airway is awake tracheal intubation (ATI) and the American Society of Anesthesiologists recommended the use of non-invasive airway management devices, including flexible intubation scope. This procedure is preferred due to its low risk of complications and high success rates.
Keywords: Awake tracheal intubation; Awake fibreoptic intubation; Difficult airway; Flexible intubation scope; Parotid abscess
Citation: Tanoto C, Charles, Senapathi TGA, Utara Hartawan IGAG. Awake intubation with intubation fiberscope in a patient with difficult intubation and difficult ventilation: a case report. Anaesth. pain intensive care 2025;29(3):699-702. DOI: 10.35975/apic.v29i3.2768
Received: May 09, 2024; Revised: October 26, 2024; Accepted: January 01, 2025