Avoiding Tracheostomy With Awake Intubation In Patient With Large Neck Mass

Proposal Number:


Proposal Type:

Medically Challenging Case Report Poster 


Amir Abdel-Kader  
Mount Sinai Hospital


Adam Levine  
Mount Sinai Hospital


74 year old female with longstanding (40 year) goiter with expansion in size over last 5 years from 7.6x7 cm to 19x21 cm and recent necrosis, ulceration of skin, bleeding presented for resection, neck dissection, and free flap reconstruction. Patient also with recent voice changes and dysphagia and with CT scan showing mass effect of upper trachea with narrowing of airway. Patient had not seen a physician for many years and was adamant about avoiding tracheostomy after surgical options were discussed with her. Patient was intubated awake and spontaneously breathing with anode endotracheal tube using fiberoptic scope after topicalization of tongue and pharynx with lidocaine. Bilateral edematous arytenoids were visualized with fiberoptic scope. Tracheostomy was avoided and patient was successfully extubated on POD 1.

Professional Category:




Supporting Image: 20190510_162414.jpg
   ·Necrotic Neck Mass

Enter up to two references.

1. Thomas T. Joseph, Jonathan S. Gal, Samuel DeMaria, Hung-Mo Lin, Adam I. Levine, Jaime B. Hyman; A Retrospective Study of Success, Failure, and Time Needed to Perform Awake Intubation. Anesthesiology 2016;125(1):105-114