Successful endotracheal intubation with Trachway after failed fiber‑optic manipulations in a patient with retropharyngeal cervical chordoma

Yi‑Ting Chen^a, Chun‑Ning Ho^b, Kuo‑Chuan Hung^b*

^aDepartment of Anesthesiology, E‑DA Hospital, Kaohsiung, Taiwan, ^bDepartment of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan

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Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation

Abstract

A retropharyngeal mass may distort the airway anatomy and reduce the space available for manipulation of intubation devices. We encountered a patient with a cervical chordoma occupying the retropharyngeal space. Fiber‑optic orotracheal intubation was attempted to secure the airway. Although the fiber‑optic bronchoscope (FOB) was successfully placed into the trachea, the tracheal tube could not be passed through the glottis. An airway was then successfully established with the Trachway device, a video‑assisted system with a rigid but malleable intubating stylet. In conclusion, although a FOB is commonly used to secure a difficult airway, the present case report demonstrates that fiber‑optic intubation is not always successful. Video intubation devices with a rigid stylet (such as Trachway) may
be helpful in patients with a cervical chordoma. We suggest this device be available as backup for patients with distorted airway anatomy.

Keywords: Chordoma, Fiber‑optic intubation, Retromolar intubation, Trachway