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A 26‐year‐old man was listed for excision of a vestibular schwannoma. Abnormally anterior palatoglossal arches were noted during pre‐operative anaesthetic evaluation (Fig. 1). The palatoglossal arches are ridges created by the palatoglossus muscles, one of the four pairs of extrinsic muscles of the tongue [1]. Rarely, the attachment of palatoglossus muscles can be so anterior that it might make displacement of the tongue challenging during laryngoscopy [2].1FigureAbnormally anterior palatoglossal arches within the patient's oral cavity.In the absence of other risk factors for difficult airway management, and considering the risk of raised intracranial pressure with awake tracheal intubation, we planned for tracheal intubation under general anaesthesia.Following induction of general anaesthesia with fentanyl 150 μg and propofol 180 mg, facemask ventilation was straightforward. Direct laryngoscopy was performed with a size 4 Macintosh blade: the tongue was displaced from right to left with ease. A grade 2a Cormack and Lehane view was obtained, and following this, rocuronium 80 mg was given. Once sufficient time had passed for the muscle relaxant to take effect, laryngoscopy was repeated, and tracheal intubation was uneventful.Abnormal airway anatomy should prompt consideration that airway management could be difficult but conventional airway management may remain appropriate following assessment. In the event of failed
Anaesthesia Reports – Wiley
Published: Jul 1, 2022
Keywords: airway management; tracheal intubation
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