Management of a Lost Airway During an Emergent Post-Glossectomy Hematoma Evacuation

CASE PRESENTATION

A 70-year-old male with oral squamous cell carcinoma presented for a hemiglossectomy with neck dissection. • The patient had an uncomplicated intubation using video laryngoscopy and was successfully extubated post-procedure. • Several hours later he was noted to have neck swelling at the incision site extending laterally to midline. • The patient was asymptomatic with a palpable, midline trachea. • He emergently returned to the OR for evacuation of the hematoma. • After discussion with the ENT team, it was determined that the lateral location of the hematoma would not interfere with intubation. • Following induction, two providers attempted glidescope intubation but were unable to visualize the glottis. • The patient could not be ventilated, resulting in severe oxygen desaturation, hypotension and bradycardia requiring epinephrine and atropine. • ENT performed an emergent tracheostomy and subsequently evacuated the hematoma.