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CASE REPORT
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 52-56

Anaesthetic management of a child for excision of extensive facial neurofibroma extending to lower neck with airway compression


Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Correspondence Address:
Dr. Sunil Rajan
Department of Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ARWY.ARWY_10_20

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A 7-year-old girl presented with a large facial plexiform neurofibroma extending from the left infraorbital region downwards up to the manubrium sternum with laryngeal compression. The child was posted for excision of the tumour, which measured 30 cm × 20 cm. Following anaesthetic induction with inhalation agents, a videoscope-assisted nasal intubation was attempted but failed. Fibreoptic-assisted intubation also failed due to inability to railroad the tube into the trachea. Finally, a stylet was passed from the oral route into the trachea under videoscopic guidance, and a 5.5 mm ID endotracheal tube was passed over it. The intraoperative period was uneventful. The patient developed stridor on extubation in the intensive care unit (ICU) on the 1st postoperative day. Due to failed reintubation in the ICU and in view of need for a secure airway during the postoperative period, a tracheostomy was performed. Flexible bronchoscopy under general anaesthesia administered through the tracheostomy 1 week later revealed oedematous vocal cords, and hence decannulation was deferred. Repeat bronchoscopy after another week showed near-normal vocal cords, larynx and subglottic region. The child was then decannulated and had an unremarkable recovery.


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