Airway evaluation and management
Table 4 shows airway status on initial presentation and findings of upper airway with a flexible laryngoscope. Thirteen (65%) patients complained of dyspnea on initial presentation. One patient presented with severely compromised airway. We evaluated signs of upper airway obstruction in all patients with a flexible laryngoscope. The most common (70%) finding was bulging of pharyngeal wall (Fig. 1B). It might be attributed to the spreading of infection from the neck to the mediastinum. Orotracheal intubation was safely undertaken by an experienced anesthesiologist. Two patients needed more time and bronchoscopy to be intubated than usual orotracheal intubation. If orotracheal intubation was done, it was kept for 12- 24 h after surgery. After extubation, we re-evaluated the upper airway with the flexible laryngoscope and identified the diminished swelling of the lateral pharyngeal wall. Three (18.8%) of 16 patients who underwent orotracheal intubation were converted to tracheotomy (late tracheotomy) due to aggravated infection (Table 5).