Use of the laryngeal mask for fibrescope–aided tracheal intubation in an awake patient with a deviated larynx

I report a case in which fibrescope–aided awake tracheal intubation was achieved using a laryngeal mask, in a patient with a mediastinal goitre in whom tracheal intubation with both a laryngoscope and a fibreoptic bronchoscope had failed. The tumour extended to the upper part of the mediastinum. The larynx and the upper segment of the trachea were displaced by the tumour. Awake tracheal intubation with both a laryngoscope and a fibreoptic bronchoscope failed. The laryngeal mask was then inserted without difficulty. After a fibreoptic bronchoscope had been covered by a plastic tube, the combination was passed through the laryngeal mask into the trachea. The fibreoptic bronchoscope and the laryngeal mask were removed, and a reinforced endotracheal tube was then inserted over the plastic tube into the trachea. The time for tracheal intubation was about 70 s. The laryngeal mask may allow easier location of the laryngeal inlet with a fibreoptic bronchoscope, and this technique is a useful alternative to the conventional technique of tracheal intubation in the patient with a deviated larynx.