Intractable course of a submandibular abscess following difficult endotracheal intubation : a case report

• Published in: Maġallat al-ṭibbiyat al-lubnāniyyat Vol. 67; no. 2; pp. 103 - 106
• Main Authors: Ayyub, Ilyan, Tohme, Joanna, Jabbur, Hisham, Shalhub, Viviane, Naccache, Nicole, Abi Lutf Allah, Antwan
• Format: Journal Article
• Language: English; French
• Published: Beyrouth, Liban Ordre des Medecins du Liban 01.04.2019
• ISSN: 0023-9852
• DOI: 10.12816/0054124

• Purpose : Failure to manage airway might lead to severe life-threatening events. Oral and pharyngeal perforation and subsequent peripharyngeal abscess formation is a perilous complication of tracheal intubation. We present the case of a difficult endotracheal intubation and delayed recognition of an associated tear in the floor of the mouth in a patient undergoing a minor surgery. We also describe the management of subsequent submandibular abscess. Clinical features : A 24-year-old male was scheduled for strabismus surgery. He was classified as Mallampati class III. Endotracheal intubation was achieved at the third attempt, using the D-Blade™ of a C-MAC™ with a stylet. Five hours after uneventful extubation, the patient complained of sore throat and a mild neck pain. He was however discharged from hospital against medical advice. Two days later, the patient presented to the emergency department after experiencing increased neck pain, odynophagia and a 39°C fever. Computed tomography scan revealed a right submandibular abscess. He was transferred to the OR for abscess drainage. Because no fiberscope was available at the time of induction, intubation was attempted using a CMAC ™ video laryngoscope. However, the abscess drained in the oral cavity. Facing difficulties to ventilate, an emergent tracheotomy was performed immediately. A tear in the floor of the mouth was identified and was surgically repaired. The patient received adequate antibiotics and fully recovered twelve days later. Conclusion: In rare cases, endotracheal intubation may lead to life-threatening pharyngoesophageal complications. Therefore, anesthesiologists must be aware of such injuries because early detection is a cornerstone to successful management of these complications.