Case reports in anesthesiology · 2026
Lingual Traction and the Lateral Decubitus Position Facilitate Awake Fiberoptic Oral Intubation in a Patient With Ehlers-Danlos Syndrome (Hypermobile Type) and Craniocervical Fixation: A Case Report.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Ramírez-Paesano Carlos, Valente-Rivero Gabriel, Rivero-Novoa Eloymar, Colina-Vargas Yerlin Andrés, Juanola-Galcerán Albert, Molins Gloria
Аннотация
BACKGROUND: Awake fiberoptic intubation (AFOI) remains the preferred technique for anticipated difficult airway management. However, severe restriction of mouth opening, fixed craniocervical anatomy, and sedation-induced hypopharyngeal collapse may substantially impair endoscopic visualization and increase procedural difficulty. Simple mechanical maneuvers that improve upper airway patency may facilitate successful intubation in these highly challenging patients.
CASE PRESENTATION: We report the airway management of a 24-year-old woman with Ehlers-Danlos-hypermobile type (EDS-HT) syndrome, previous craniocervical fusion, severe temporomandibular dysfunction, and a history of a prior cannot intubate, cannot oxygenate event requiring emergency tracheostomy. Preoperative evaluation demonstrated extreme anatomical airway restriction, including complete absence of cervical extension, severely limited mouth opening, and ultrasonographic evidence of markedly reduced submandibular compliance (hyomental distance 2.8 cm; hyomental distance ratio 1.0). During the first-stage spinal surgery, awake fiberoptic orotracheal intubation in the supine position, with dexmedetomidine-light sedation and local anesthesia, was initially hindered by severe hypopharyngeal collapse. Application of lingual traction immediately restored glottic exposure, allowing successful first-attempt intubation. Seven days later, during the second-stage procedure, AFOI was performed in the left lateral decubitus position combined with lingual traction. This approach further improved airway patency, reducing the time to glottic visualization from 15 to 5 s and total intubation time from 90 to 30 s, while maintaining first-pass success.
CONCLUSION: This case illustrates that combining lingual traction with lateral decubitus positioning can mechanically optimize upper airway patency during AFOI in patients with fixed craniocervical anatomy and EDS-HT patients. These simple, low-cost, and readily reproducible maneuvers may represent valuable adjuncts when conventional airway techniques are limited or contraindicated.
CASE PRESENTATION: We report the airway management of a 24-year-old woman with Ehlers-Danlos-hypermobile type (EDS-HT) syndrome, previous craniocervical fusion, severe temporomandibular dysfunction, and a history of a prior cannot intubate, cannot oxygenate event requiring emergency tracheostomy. Preoperative evaluation demonstrated extreme anatomical airway restriction, including complete absence of cervical extension, severely limited mouth opening, and ultrasonographic evidence of markedly reduced submandibular compliance (hyomental distance 2.8 cm; hyomental distance ratio 1.0). During the first-stage spinal surgery, awake fiberoptic orotracheal intubation in the supine position, with dexmedetomidine-light sedation and local anesthesia, was initially hindered by severe hypopharyngeal collapse. Application of lingual traction immediately restored glottic exposure, allowing successful first-attempt intubation. Seven days later, during the second-stage procedure, AFOI was performed in the left lateral decubitus position combined with lingual traction. This approach further improved airway patency, reducing the time to glottic visualization from 15 to 5 s and total intubation time from 90 to 30 s, while maintaining first-pass success.
CONCLUSION: This case illustrates that combining lingual traction with lateral decubitus positioning can mechanically optimize upper airway patency during AFOI in patients with fixed craniocervical anatomy and EDS-HT patients. These simple, low-cost, and readily reproducible maneuvers may represent valuable adjuncts when conventional airway techniques are limited or contraindicated.