Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2022; 10(23): 8249-8254
Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8249
Aspiration as the first-choice procedure for airway management in an infant with large epiglottic cysts: A case report
Jian-Qiao Zheng, Li Du, Wei-Yi Zhang
Jian-Qiao Zheng, Wei-Yi Zhang, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Li Du, Department of Anesthesiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, Sichuan Province, China
Author contributions: Zheng JQ and Du L drafted the manuscript; Zhang WY supervised the writing of the manuscript; both authors participated in the management of the patient in this case report, and read and approved the manuscript.
Informed consent statement: Informed written consent was obtained from the patient’s father for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) statement, and the manuscript was prepared and revised according to the CARE Checklist (2016) statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Yi Zhang, MD, PhD, Professor, Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. anesthesiology_scu@163.com
Received: December 1, 2021
Peer-review started: December 1, 2021
First decision: March 15, 2022
Revised: June 3, 2022
Accepted: June 21, 2022
Article in press: June 21, 2022
Published online: August 16, 2022
Processing time: 242 Days and 19.6 Hours
Abstract
BACKGROUND

Epiglottic cysts is a rare but potentially lethal supraglottic airway pathology in infants due to the high risk of cannot intubation or cannot ventilation. Awake fiberoptic intubation appeared to be the safest technique, but it is very challenging in infants with large epiglottic cysts. Even it has the risk of airway loss. We report that cyst aspiration is an effective treatment as the first-choice procedure for airway management in an infant with large epiglottic cysts.

CASE SUMMARY

A 46-day-old male infant weighing 2.3 kg presented to the emergency room with difficulty feeding, worsening stridor, and progressive respiratory distress. Epiglottic cysts was diagnosed, but fibro bronchoscopy examination failed, as the fiberoptic bronchoscope was unable to cross the epiglottic cysts to the trachea. The infant was transferred to the operating room for emergency cystectomy under general anesthesia. Spontaneous respiration was maintained during anesthesia induction, and cyst aspiration was performed as the first procedure for airway management under video laryngoscopy considering that the preoperative fibro bronchoscopy examination failed. Then, the endotracheal tube was intubated successfully. Cystectomy was performed uneventfully, and the infant was safely transferred to the intensive care unit after surgery. The infant was extubated smoothly on the third postoperative day and discharged on the eighth day after surgery. On follow-up 1 year after the surgery, a normal airway was found by fibro bronchoscopy examination.

CONCLUSION

Epiglottic cyst aspiration can be considered the first procedure for airway management in infants with large epiglottic cysts.

Keywords: Epiglottic cysts; Infant; Airway management; Difficult airway; Case report

Core Tip: Epiglottic cysts is a rare but potentially lethal supraglottic airway pathology in infants. Surgical cystectomy is the mainstay and established treatment method, which poses a significant anesthetic challenge for airway management due to the increased risk of difficult tracheal intubation and airway occlusion resulting in hypoventilation, hypoxemia, and even death. In this report, cysts aspiration was selected as the first treatment for airway management in an infant with large epiglottic cysts, and an endotracheal tube was successfully intubated after cysts aspiration. This anesthesia technique is considered as the first choice for airway management in infants with large epiglottic cysts.