Worst-case scenario intubation of laryngeal granuloma: a case report

BACKGROUND: Intubation of patients with laryngeal granulomas on the vocal folds are sometimes difficult to manage because of potential airway obstruction. Laryngeal granulomas usually have flexible stalks where they attach to the vocal folds. We report a worst-case scenario of dislocation of the laryngeal granuloma during induction of anaesthesia. CASE PRESENTATION: We present a case of laryngeal granulomas on the posterior vocal fold. A 20-year-old woman had an approximately 10-mm tumour in the laryngeal arytenoid region. Manual ventilation resulted in the tumour lodging in the subglottis and the inflated cuff of the intubation tube successfully returned it to its original position during tube withdrawal. Images were obtained using an Airway Scope® (Hoya-Pentax, Tokyo, Japan) and a video laryngoscope. CONCLUSION: In our case, the tumour was benign and relatively small in size; therefore, we did not select tracheotomy as an airway management strategy. The case had a granulomatous tumour arising from the posterior vocal folds on the right side, and the tumour was very flexible. To promptly gain control of the airway in such a case using direct laryngoscopy, thus avoiding tracheotomy, other strategies are suggested, such as bronchoscopic visualization with awake or semi-awake intubation.