Airway Management After Oral Cancer Surgery (Preview)

Case presentation:

This is a 72 years old male patient, s/p tongue and pharyngeal cancer resection, presenting for a diagnostic laryngoscopy and esophagoscopy with esophageal dilatation.

In 2001, he underwent base of the tongue and pharyngeal resection, pharyngoplasty, partial epiglottectomy and vallecular resection, and placement of the temporary tracheostomy. This was followed by multiple cycles of radiotherapy and chemotherapy.

The patient’s past medical history is also remarkable for a recent pneumonia (2 months ago), non-small cell lung cancer (lobectomy in 2003), and a distant history of gastric ulcer. His other past surgical history includes several minor abdominal surgeries. He does not recall having been told that he had a “difficult airway” in the past.

On the day of surgery, the patient appears in no apparent distress and is cooperative. His vital signs are stable, weight 93 kg, height 186 cm. His airway exam can be appreciated from Figures 1-3.
 

Figure 1.

Figure 2.

Figure 3.

The surgeon requests a 5.0 mm ID microlaryngeal (MLT) endotracheal tube for the procedure.

How would you manage this patient’s airway?