**Base of Tongue Lesion:**

**Airway Pathology:** large midline tumors of base of the tongue can certainly present real difficulty for airway management. All of these patients should have preoperative fiberoptic nasal pharyngoscopy and CT scan. A CT scan shows the depth of tumor infiltration and involvement of epiglottis and pharynx.

**Airway Management:** Rigid tissue fixation and/or bleeding from the tumor often preclude successful oral laryngoscopy and intubation. Intubation with standard laryngoscopy in this situation is predictably difficult. A wake

**139**

**Figure 11.** *Large goiter removal.*

**Figure 10.**

is the most appropriate technique.

determine the extent of the damage.

**Vocal cord tumors for LASER cordectomy:**

involved vocal cord with sufficient margin (**Figure 15**).

spontaneous breathing with nasopharyngeal oxygen insufflations.

*Airway Management in Head and Neck Pathology DOI: http://dx.doi.org/10.5772/intechopen.94498*

*Large thyroid goiter with tracheal compression and deviation.*

fiberoptic-trachesoscopy and intubation with the patient spontaneously ventilating

Symptoms range from mild dysphonia to marked stridor and severe respiratory distress. For T1 and T2 glottic cancers, **LASER** cordectomy is the standard treatment option. Inserting a laryngoscope and using **LASER** beam to resects the

**Airway management:** Endoscopic excision of laryngeal vocal cord tumors requires adequate surgical exposure and thus special airway management, many options exist: Intubation with a special **LASER** tube, jet ventilation catheter, or

**LASER** use mandates that no combustible materials come in the field to avoid airway fires. *If fire occur*s*, the following urgent steps should be done immediately: stop ventilation, stop oxygen, remove the hot endotracheal tube, and wash with sterile saline to extinguish the fire.* Bronchoscopy should be next done to remove any debris and to *Airway Management in Head and Neck Pathology DOI: http://dx.doi.org/10.5772/intechopen.94498*

*Special Considerations in Human Airway Management*

**Airway Management:** Large extra-tracheal lesions should engender caution concerning airway management. In these cases, with a suspected difficult airway, a wake intubation is the most appropriate. The possible options: blind nasal, awake

• *A wake* oral *laryngoscopy* is unlikely to be successful in the presence of big

• *Blind nasal intubation* could be performed, but with the mass causing some compression and distortion of the airway, it may be unsuccessful (**Figures 10** and **11**).

**Airway Pathology:** The oropharynx extends from the level of the hard palate superiorly to the level of the hyoid bone inferiorly. Laterally it houses the tonsils and

**Airway Pathology:** large midline tumors of base of the tongue can certainly

present real difficulty for airway management. All of these patients should have preoperative fiberoptic nasal pharyngoscopy and CT scan. A CT scan shows the depth of tumor infiltration and involvement of epiglottis and

**Airway Management:** Rigid tissue fixation and/or bleeding from the tumor often preclude successful oral laryngoscopy and intubation. Intubation with standard laryngoscopy in this situation is predictably difficult. A wake

**Airway Management:** The main concern is the conversion of a partially obstructed airway (by the tumor) to a completely obstructed (by swelling and/or bleeding) with upper airway or tumor manipulation. In cases of big oropharyngeal tumors, secure airway management requires the need to guarantee the airway before trying a definitive airway and avoidance of any instrumentation or manipulation of the pathology. Trans-tracheal puncture and block techniques are secure means to ventilate and oxygenate patients while more definitive maneuvers are

oral laryngoscopy, fiberoptic intubation or a wake tracheotomy.

• *Fiberoptic tracheoscopy provide perhaps the highest reliability*

goiter and significant airway distortion.

**Oropharyngeal cancers:**

*Obstructive cancer of the hypopharynx.*

performed (**Figures 12**–**14**). **Base of Tongue Lesion:**

faucial pillars.

**Figure 9.**

**138**

pharynx.

**Figure 10.** *Large thyroid goiter with tracheal compression and deviation.*

**Figure 11.** *Large goiter removal.*

fiberoptic-trachesoscopy and intubation with the patient spontaneously ventilating is the most appropriate technique.

## **Vocal cord tumors for LASER cordectomy:**

Symptoms range from mild dysphonia to marked stridor and severe respiratory distress. For T1 and T2 glottic cancers, **LASER** cordectomy is the standard treatment option. Inserting a laryngoscope and using **LASER** beam to resects the involved vocal cord with sufficient margin (**Figure 15**).

**Airway management:** Endoscopic excision of laryngeal vocal cord tumors requires adequate surgical exposure and thus special airway management, many options exist: Intubation with a special **LASER** tube, jet ventilation catheter, or spontaneous breathing with nasopharyngeal oxygen insufflations.

**LASER** use mandates that no combustible materials come in the field to avoid airway fires. *If fire occur*s*, the following urgent steps should be done immediately: stop ventilation, stop oxygen, remove the hot endotracheal tube, and wash with sterile saline to extinguish the fire.* Bronchoscopy should be next done to remove any debris and to determine the extent of the damage.

**Figure 13.** *Another example of a large oropharyngeal tumor arising from the right tonsil.*
