Unusual airway difficulty in the acromegalic patient - indications for tracheostomy

Abstract

In the acromegalic patient described, massive hypertrophy of the soft tissue obliterated all views of the glottis and the endotracheal tube was passed blindly into the larynx after several attempts. Additional trauma of intubation added an element of edema to the already hypertrophied mucosal folds in the upper airway. It was feared that extubation would be followed by complete supraglottic obstruction. Elective tracheostomy avoided a potential catastrophic airway problem, did nothing to prolong postoperative morbidity, and appears to be a therapeutic modality to be considered in such situations.