Successful Management of a Patient with Supraglottic Laryngeal Mass Causing Near Complete Airway Obstruction - A Case Report

Introduction: We describe the successful management of a huge supraglottic cyst involving the entire left side of the false vocal cord scheduled for microlaryngeal surgery.
Case Report: A 45-year-old American Society of Anesthesiologists (ASA) 1 patient presented with a change of voice, dysphagia, and noisy breathing for three months. Indirect laryngoscopy (IDL) revealed a pedunculated cystic lesion 4x4 cm in the supraglottis, covering the entire glottic opening. Computed tomography (CT) of the neck showed a 2.7 x 2.5 x 2.3 cm cyst arising from the left aryepiglottic fold, covering the entire glottis.  
Awake FOB with airway blocks and local anesthesia of the nose and airway was performed by negotiating the FOB beyond the cyst, passing the scope into the esophagus, and then withdrawing it with anteflexion to enter the trachea. Videolaryngoscopy was used while railroading the ET tube to prevent rupture of the cyst. After surgery, smooth extubation was performed.
Conclusion: Management of a difficult airway is a crucial aspect of patient safety, which can be accomplished by using a hybrid intubation technique (FOB + VL) with adequate preparation of the airway.