Fiberoptic nasal intubation in a patient with huge laryngeal cyst

Huge laryngeal cyst is rare, but may cause difficulty or inability in tracheal intubation during induction of general anesthesia. A 69-year-old patient was scheduled for laryngomicroscopic cystectomy. In this patient, we examined two methods of oro-tracheal intubation either with rigid laryngoscopy or flexible fiberscopy using transnasal fiberoptic monitoring. Direct laryngoscopy failed to expose the epiglottis because of large cyst being fragile and easy to bleed. And even oral fiberscopy intubation was also difficult since a large mass hindered acquiring a suitable view. However, trans-nasal fiberscopy monitoring could guide the oro-tracheal fiber into the trachea for intubation. When an anesthesiologist can predict the abnormality of epiglottis, this combination might be recommended for difficult airway and intubation. Postoperative respiratory management under intubating state was necessary because of bleeding, airway edema, and deviation of the larynx after tumor resection. We reported anesthetic management of a patient with epiglottis gigantic cyst occupying the laryngopharyngeal airway. It is a rare tumor leading to difficulty of induction of anesthesia and necessitating postoperative intubated respiratory care.