Near-Complete Airway Obstruction Caused by a Retropharyngeal Hematoma Following Anterior Cervical Discectomy and Fusion Managed With Nasotracheal Intubation.

Postoperative retropharyngeal hematoma after anterior cervical spine surgery is a rare but potentially life-threatening complication because it can rapidly cause airway obstruction. In addition, it may result in an unanticipated difficult airway due to anatomical distortion. A patient underwent an anterior cervical discectomy and fusion (ACDF) at the C3-C5 level for dropped head syndrome. Approximately one hour after surgery, the patient developed sudden dyspnea and agitation. Emergency reintubation was attempted; however, direct oral intubation was extremely difficult because the glottis had shifted superiorly due to severe pharyngeal compression. Fiberoptic nasotracheal intubation using a 6.5-mm endotracheal tube was successfully performed. Computed tomography (CT) revealed a large retropharyngeal hematoma causing near-complete airway obstruction. Postoperative retropharyngeal hematoma can cause sudden airway obstruction and an unanticipated difficult airway. Prompt recognition and appropriate airway management are essential.