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Letter to the Editor
Online Published: 25 Aug 2025
 


Systematic Approach to Awake Fibreoptic Intubation in a Post-Hemi-Mandibulectomy Patient with Distorted Airway Anatomy

Subha Jose Vazhakalayi, Kshitija Devendra Bora, Sravya Bejugama.


Abstract
Managing the airway in patients with previous head and neck surgeries can be particularly challenging, especially when significant anatomical distortion and restricted mouth opening are present. We describe the case of a 38-year-old man with a history of hemi-mandibulectomy, scheduled for wide local excision and neck dissection with flap reconstruction. Given the difficult airway anticipated, we opted for an awake fibreoptic nasotracheal intubation. A careful, stepwise approach was followed—starting with thorough airway topicalization using nebulized, sprayed, and transtracheal lignocaine, combined with mild sedation for comfort. The fibreoptic bronchoscope provided continuous visualization of the airway, allowing for smooth passage of the endotracheal tube while maintaining spontaneous ventilation. The intubation was successful on the first attempt, and the surgery proceeded without any airway-related issues. This case highlights how thoughtful preparation, effective airway anesthesia, and a structured plan are key to safely managing complex airways, particularly in patients with head and neck pathology.

Key words: Difficult airway, awake fibreoptic intubation, head and neck surgery, distorted airway anatomy, airway topicalization, nasotracheal intubation, mandibulectomy


 
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How to Cite this Article
Pubmed Style

Vazhakalayi SJ, Bora KD, Bejugama S. Systematic Approach to Awake Fibreoptic Intubation in a Post-Hemi-Mandibulectomy Patient with Distorted Airway Anatomy. J Surg Res Rev. Online First: 25 Aug, 2025. doi:10.5455/JSRR.20250703081705

Web Style

Vazhakalayi SJ, Bora KD, Bejugama S. Systematic Approach to Awake Fibreoptic Intubation in a Post-Hemi-Mandibulectomy Patient with Distorted Airway Anatomy. https://www.wisdomgale.com/jsrr/?mno=268582 [Access: August 27, 2025]. doi:10.5455/JSRR.20250703081705

AMA (American Medical Association) Style

Vazhakalayi SJ, Bora KD, Bejugama S. Systematic Approach to Awake Fibreoptic Intubation in a Post-Hemi-Mandibulectomy Patient with Distorted Airway Anatomy. J Surg Res Rev. Online First: 25 Aug, 2025. doi:10.5455/JSRR.20250703081705


Vancouver/ICMJE Style

Vazhakalayi SJ, Bora KD, Bejugama S. Systematic Approach to Awake Fibreoptic Intubation in a Post-Hemi-Mandibulectomy Patient with Distorted Airway Anatomy. J Surg Res Rev, [cited August 27, 2025]; Online First: 25 Aug, 2025. doi:10.5455/JSRR.20250703081705


Harvard Style

Vazhakalayi, S. J., Bora, . K. D. & Bejugama, . S. (2025) Systematic Approach to Awake Fibreoptic Intubation in a Post-Hemi-Mandibulectomy Patient with Distorted Airway Anatomy. J Surg Res Rev, Online First: 25 Aug, 2025. doi:10.5455/JSRR.20250703081705


Turabian Style

Vazhakalayi, Subha Jose, Kshitija Devendra Bora, and Sravya Bejugama. 2025. Systematic Approach to Awake Fibreoptic Intubation in a Post-Hemi-Mandibulectomy Patient with Distorted Airway Anatomy. Journal of Surgical Research and Reviews, Online First: 25 Aug, 2025. doi:10.5455/JSRR.20250703081705


Chicago Style

Vazhakalayi, Subha Jose, Kshitija Devendra Bora, and Sravya Bejugama. "Systematic Approach to Awake Fibreoptic Intubation in a Post-Hemi-Mandibulectomy Patient with Distorted Airway Anatomy." Journal of Surgical Research and Reviews Online First: 25 Aug, 2025. doi:10.5455/JSRR.20250703081705


MLA (The Modern Language Association) Style

Vazhakalayi, Subha Jose, Kshitija Devendra Bora, and Sravya Bejugama. "Systematic Approach to Awake Fibreoptic Intubation in a Post-Hemi-Mandibulectomy Patient with Distorted Airway Anatomy." Journal of Surgical Research and Reviews Online First: 25 Aug, 2025. Web. 27 Aug 2025 doi:10.5455/JSRR.20250703081705


APA (American Psychological Association) Style

Vazhakalayi, S. J., Bora, . K. D. & Bejugama, . S. (2025) Systematic Approach to Awake Fibreoptic Intubation in a Post-Hemi-Mandibulectomy Patient with Distorted Airway Anatomy. Journal of Surgical Research and Reviews, Online First: 25 Aug, 2025. doi:10.5455/JSRR.20250703081705


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