Difficult airway management due to obesity and lingual tonsillar hyperplasia

We experienced anesthesia for a female patient of BMI 39.2 with unanticipated lingual tonsillar hyperplasia. At the induction of anesthesia, both mask ventilation and tracheal intubation were difficult due to the lingual tonsillar hyperplasia. However, tracheal intubation was performed by Intubating LMA with the fiberoptic bronchoscopy. After the placing of TE (the catheter for tracheal tube exchanger), the tracheal tube was extubated without any airway trouble. Following the extubation, the opening of the respiratory tract was evaluated by TE and the fiberoptic bronchoscopy. In this case we confirmed that the ASA difficult airway algorithm was also useful in the presence of lingual tonsillar hyperplasia.