The Rescue of the Failed Glidescope and Flexible Fiberoptic Intubation with the Bonfils Stylet

A comprehensive history and examination of the airway is essential prior to any surgery to anticipate and plan the appropriate management of the airway. This assumes even greater importance in patients with head and neck pathology where the incidence of a difficult intubation is quoted as high as 12% compared to the 2% for the general surgical population.¹

We report the airway management of a 61 y.o. female who was scheduled for a panendoscopy and biopsy procedure. She had already undergone fine needle aspiration of a buccal mass, which was diagnosed as lymphoid tissue with the possibility of surrounding malignancy.

Past medical history was significant for post-polio syndrome resulting in pain and fatigue, and necessitating the use of an electric wheelchair. She could, however, climb one flight of stairs. Other pertinent history included post-herpetic neuralgia, controlled hypertension, hypercholesterolaemia, smoking, asthma, and dyspepsia for which she used omeprazole. 

The airway exam revealed Mallampati I class airway, normal mandibular protrusion, thyromental distance
of  > 6.5 cm, and no restriction in neck movement. The patient also mentioned that on lying flat she felt some obstruction intermittently in the back of her throat, which was relieved when she sat up. She denied any symptoms of stridor or odynophagia. ...