AIRWAY MANAGEMENT OF A VALLECULAR CYST EXCISION-A NIGHTMARE TO ANAESTHETISTS

Vallecular cysts are mucus retention cyst of salivary gland and might be a cause ofobstructing the laryngeal inlet posing a threat to anaesthetist for airway management(1).We present the airway management of an adult patient with difficult airway with a large vallecular cyst. A16 year old female patient with a vallecular cyst posted for robotic assisted vallecular cyst excision under general anaesthesia. After induction of general anaesthesia, laryngoscopy was attempted with C-mac blade size-3 and no laryngeal structures were seen except the epiglottis. We were unable to lift the epiglottis to visualise the vocal cords since the cyst was present in the space between base of tongue and epiglottis. An immediate plan of fibreoptic bronchoscopy guided intubation was planned. In the meantime, patient was being ventilated by bag and mask ventilation. After placing the Fibreopticbronchoscope in the trachea just above the carina, railroading of the endotracheal tube was difficult.Hence,we decided to introduce the Video laryngoscope to visualise the passage of the endotracheal tube which was being guided by fibreopticbronchoscope. The main aim is to prevent damage to the vallecular cyst and to ensure safe placement of endotracheal tube and adequate ventilation of the patient to prevent potential airway related complications.