Abstract

A 48-year-old male presented for microlaryngoscopy and vocal fold polypectomy, which was complicated by polyp displacement into the lower respiratory airway during direct laryngoscopy and tracheal intubation. It is the first reported incidence of such a case. Following preoperative assessment and preparation, anaesthesia was induced and the airway secured using direct laryngoscopy and tracheal intubation with a microlaryngoscopy tube (MLT), which was reported uneventful. On microlaryngoscopy, the surgeon who had diagnosed the polyp in the outpatient clinic noted the polyp had disappeared. It was determined that the polyp had been sheared by the MLT. A fibreoptic scope was passed via the MLT, showing the polyp at the entrance to the right main bronchus. The polyp was successfully extracted via rigid bronchoscopy. The subsequent surgery and post-operative recovery were otherwise uneventful. Complications of bronchial occlusion were avoided by early recognition of the issue. Case reflection identifies many potential learning points. Head, neck and airway lesions add a dimension of complexity to anaesthetic practice. Preoperative assessment requires review of relevant endoscopic and radiographic images, and case discussion with the surgeon to identify potential issues. The location, size and vulnerability of any potentially complicating lesions must be known. The vocal folds and documented lesions should be visualised throughout intubation, and excess force during intubation avoided. This may require the use of alternative devices or techniques. Preoperative laryngoscopy by the operating surgeon or photo-documentation of the lesion may be necessary for microlaryngoscopies where the original physician who noted the abnormality cannot be present in the operating theatre.

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