Anatomical variant of the glottis: a difficult airway?

Abstract

A 70-year-old man with prostate neoplasia. Finding in the extension study of a lung mass compatible with lung neoplasia. He was referred to the pulmonology service for study.

Appointment for diagnostic fiberoptic bronchoscopy.

Obese patient with difficult airway predictors: short neck, III / IV mesh, thyromental distance <6cm. Fiberoptic bronchoscopy is performed under deep sedation.

When introducing the fiberoptic bronchoscope, anatomical variation with significant glottic destructuring, poor differentiation of the epiglottis, arytenoids, and adjacent structures was visualized. The entrance to the trachea is intuited by the appearance of a small opening hole with the inspiration of the patient.

This image shows that the difficulty for intubation not only corresponds to poor visualization of the airway due to difficulty in direct or indirect laryngoscopy maneuvers, but also due to the existence of non-pathological anatomical variants that represent a challenge even in experienced hands.