Intended for healthcare professionals

Rapid response to:

Minerva

Minerva

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c90 (Published 13 January 2010) Cite this as: BMJ 2010;340:c90

Rapid Response:

Lingual Tonsil - Considerations for Airway Management

Kahal & Malik reported that bleeding or airway obstruction may be
a complication of lingual thyroid.
Base of tongue swellings, such as lingual thyroid or lingual tonsil can be
a major challenge to airway management during anaesthesia.(1)
Standard techniques for airway control may be compromised. Direct
laryngoscopy with a McIntosh (curved) laryngoscope relies on placement of
the blade in the vallecula and base of tongue swellings interfere with
this. Additionally, these swellings may fragment or bleed following
instrumentation.

Use of laryngeal masks for airway control may not be successful.(2) Awake
fibreoptic intubation may be needed as "Plan A". Rescue techniques, "Plans
B and C" (such as cannula cricothyroidotomy or surgical airway) must be
part of airway management options.(3)

(1) Buckland RW, Pedley J. Lingual thyroid - a threat to the airway;
Anaesthesia 2000;55:1103-5

(2) Langenstein H, Andres AH. Do not rely on a laryngeal mask in major
periglottic pathology; BJA 1999;83:685-7

(3) Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society
guidelines for the management of the unanticipated difficult intubation;
Anaesthesia 2004;59:675-94

Competing interests:
None declared

Competing interests: No competing interests

01 February 2010
Genevieve R Lowe
ST3 Anaesthesia
Dewi Williams, Paul Jefferson, David Ball
Dumfries & Galloway Royal Infirmary, Dumfries DG1 4AP