Difficult intubation caused by an immature upper airway in a patient with cri-du-chat syndrome: a case report

Laryngeal Findings in a 20-Month-Old With Cri du Chat Syndrome

Laryngeal anatomical variations in Cri du Chat syndrome remain incompletely characterized in the medical literature, with few published photographic documentations. We present a case of a 20-month-old male with confirmed 5p15 deletion who presented with congenital inspiratory stridor and dysphagia. Videofluoroscopic evaluation at 13 months demonstrated aspiration of thin liquids. Microlaryngobronchoscopy revealed a Cormack-Lehane grade 3 view with a retroflexed epiglottis secondary to tight aryepiglottic folds, and laterally positioned false vocal cords resulting in broad, flat ventricles. Bilateral aryepiglottic fold division improved direct laryngoscopic visualization to Cormack-Lehane grade 1. This report provides detailed laryngeal characterization with photographic documentation, contributing to the understanding of airway variations in this syndrome. Recognition of these anatomical features is crucial for optimizing airway management strategies in this patient population. Laryngoscope, 135:1774-1776, 2025.

Intubation of underestimated airway in a patient with epiglottis adhesion to the posterior wall of the laryngeal cavity -A case report

BACKGROUND

Epiglottis abnormality is rare condition and can lead embarrassing intubation to anesthesiologists. Here, we reported a case of successful management in a patient with unexpected hidden vocal cords due to epiglottis adhesion to the posterior wall of the laryngeal cavity.

CASE

A 60-year-old female with no underlying disease was scheduled for general anesthesia to undergo a left-cochlear implant operation. After the induction procedure (including intravenous injection of rocuronium), an epiglottic adhesion to the posterior wall of the laryngeal cavity and invisible vocal cords were confirmed. Although the first trial of intubation failed, the patient's airway was successfully managed using a technique that combined a video-styletscope (Markstein Sichtec Medical Co., 5.0 mm ID) with a video-laryngoscope (Insighters ®, Cedrus Medical).

CONCLUSIONS

Anesthesiologists may unexpectedly encounter asymptomatic abnormal airways with unknown causes. In such a situation, it is essential to establish a strategy and to select appropriate device according to patient circumstances.

Perioperative Care of a Child With Cri Du Chat Syndrome

Cri du chat syndrome (CdCS) is a chromosomal disorder resulting from a deletion in the short arm of chromosome 5. Anatomical abnormalities of the larynx result in a distinctive high-pitched, cat-like cry for which the disorder is named. Typical findings of the syndrome involve the upper airway, cardiovascular, and central nervous system (CNS). Of particular concern during anesthetic care is the potential for airway abnormalities leading to difficulties with endotracheal intubation as well as the presence of congenital heart disease (CHD). We present a 15-month-old child with CdCS who required anesthetic care during direct laryngoscopy and supraglottoplasty. The perioperative concerns of such patients are discussed, and previous reports of anesthetic care reviewed.