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).