Intubation difficulty due to cervical osteophytes (case report)

Abstract

Cervical osteophytes are hypertrophic lesions and they are generally asymptomatic. If symptomatic, the symptoms are usually dysphagia, odynophagia, otalgia. They rarely cause dyspnea. Respiratory distress due to cervical osteophytes was reported in only a few cases in English medical literature. Besides mechanical obstruction in the airway they may cause ulcerations and edema at postericoid region and all these may lead to emergency conditions (i.e. intubation difficulty) during anesthesia induction. A 68 year old male patient with complaints of walking difficulty, numbness and pain in the right leg was admitted to neurosurgery department of our institution. After physical examination and radiological evaluation a diagnosis of lumbar disc hernia was decided. A very mild dyspnea complaint was obtained from the history. Lateral neck radiogram revealed cervical osteophytes narrowing the airway. An operation was planned for lumbar disc hernia. Before the operation precautions against possible intubation difficulty during anesthesia induction were taken. As predicted before the operation, the patient could not be intubated endotracheally and a surgical tracheostomy was performed by an otolaryngologist. The cervical osteophytes were resected in a second operation by median pharyngotomy route by otolaryngologic surgeons. In this report, unexpected airway problems in asymptomatic or minimally dyspncic patients like ours were discussed and the anesthetic management of this kind of patients are summarized.