acute lingual tonsillitis,
lingual tonsillar abscess, lingual thyroid,
and thyroglossal cysts
are recognized causes of respiratory obstruction contributing to difficult mask ventilation and tracheal intubation. External physical examination of the airway will not identify patients with a supraepiglottic mass. The lingual tonsils, located at the posterior section of the tongue, are not visible to simple inspection of the oropharynx. If ventilation
face mask or LMA is acceptable and oxygenation is maintained at a satisfactory level, fiberoptic intubation can be applied successfully, as was the case for the 27 anesthetized patients in this report. With a fiberscope, atraumatic intubation and evaluation of an airway are possible. When failed intubation is associated with difficult or impossible mask ventilation (cannot intubate-cannot ventilate), establishing ventilation, not tracheal intubation, becomes the primary concern. The LMA has been used in cannot-intubate-cannot-ventilate situations caused by LTH with success
or with partial success.
In one patient, ventilation could not be established with an LMA.
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Laryngeal mask placement requires less time than most intubation techniques and is less invasive than other ventilatory devices and tracheostomy. If an airway cannot be established with a laryngeal mask, a Combitube (Kendall Health Care), transtracheal jet ventilation, or cricothyrotomy are other options.