Intractable course of a submandibular abscess following difficult endotracheal intubation : a case report

الملخص FRE

• Purpose : Failure to manage airway might lead to severe life-threatening events.

Oral and pharyngeal perforation and subsequent peripharyngeal abscess formation is a perilous complication of tracheal intubation.

We present the case of a difficult endotracheal intubation and delayed recognition of an associated tear in the floor of the mouth in a patient undergoing a minor surgery.

We also describe the management of subsequent submandibular abscess.

Clinical features : A 24-year-old male was scheduled for strabismus surgery.

He was classified as Mallampati class III.

Endotracheal intubation was achieved at the third attempt, using the D-Blade™ of a C-MAC™ with a stylet.

Five hours after uneventful extubation, the patient complained of sore throat and a mild neck pain.

He was however discharged from hospital against medical advice.

Two days later, the patient presented to the emergency department after experiencing increased neck pain, odynophagia and a 39°C fever.

Computed tomography scan revealed a right submandibular abscess.

He was transferred to the OR for abscess drainage.

Because no fiberscope was available at the time of induction, intubation was attempted using a CMAC ™ video laryngoscope.

However, the abscess drained in the oral cavity.

Facing difficulties to ventilate, an emergent tracheotomy was performed immediately.

A tear in the floor of the mouth was identified and was surgically repaired.

The patient received adequate antibiotics and fully recovered twelve days later.

Conclusion: In rare cases, endotracheal intubation may lead to life-threatening pharyngoesophageal complications.

Therefore, anesthesiologists must be aware of such injuries because early detection is a cornerstone to successful management of these complications.