Difficult nasal intubation in patients with cancer of the tongue and tonsils

Abstract

Introduction: Airway management in patients with cancer of the tongue or tonsils can be complicated. Depending on its size and localization tumor can lead to obstruction of the upper airway. 
The Aim of the study is to determine and characterize the frequency of difficult nasal intubation in patients undergoing cancer surgery of the tongue and tonsils.
Materials and methods: A 4-year prospective cohort study of 40 patients who underwent major oral cancer surgery in the Department of ENT Surgery; University Hospital „Queen Giovanna“- ISUL; Medical University-Sofia.
Results and discussion: The mean age of the patients is 61.75 years. We found that 77.5% of the patients are men and 22.5% are women. In the 1st group – patients with cancer of the tongue the frequency of difficult nasal intubation (IDS ≥ 5) was 15% or 3 of the patients. In the 2nd group – patients with cancer of the tonsils the frequency of difficult nasal intubation was 5% or 1 of the patients. There are a number of options available to achieve tracheal intubation in patients with cancer of the tongue and tonsils. In the published literature there is no comparison between different techniques. The decision to proceed with a specific technique will be guided by the airway anatomy of patient, the availability of appropriate equipment and the skills of the multidisciplinary airway team.
Conclusion: Patients with cancer of the tongue are characterized with higher frequency of difficult nasal intubation than patients with cancer of the tonsils.