Case Report Fiberoptic nasopharyngoscopy for evaluating a potentially difficult airway in a patient with elevated intracranial pressure ☆,☆☆,★ Lakshmi N. Kurnutala MD (Assistant Professor) a, ⁎ , Gurneet Sandhu MD (Assistant Professor) b , Sergio D. Bergese MD (Professor) b a University of Mississippi Medical Center, Jackson, MS b The Ohio State University Wexner Medical Center, Columbus, OH Received 18 March 2016; revised 3 May 2016; accepted 4 May 2016 Keywords: Difficult airway; Fiberoptic nasopharyngoscopy; Laryngeal carcinoma Abstract A 62-year-old man with a left temporal lobe tumor was scheduled for a semiurgent craniotomy for tumor excision. Previously, the patient had a laryngeal carcinoma that was resected and treated with chemo- therapy and radiotherapy and a history of laryngeal biopsy with awake fiberoptic intubation. Because a dif- ficult airway was anticipated, awake fiberoptic nasopharyngoscopy of the airway was performed under topical anesthesia in the operating room. This revealed a narrow glottic opening with no supraglottic pathol- ogy or friable tissue. Based on these airway observations, we proceeded safely with intravenous induction and secured the airway in a controlled fashion, thereby minimizing the risk of increased intracranial pressure and catastrophic complications. Nasopharyngoscopy can be used safely to evaluate the upper airway to strat- ify airway management in patients with a history of head and neck cancer presenting for neurosurgical pro- cedures in the setting of elevated intracranial pressure. © 2016 Elsevier Inc. All rights reserved. 1. Case report A 62-year-old white man weighing 85 kg (body mass index 28.4 kg/m 2 ) presented with headache, intermittent right-sided weakness, and associated numbness. The neurologic examina- tion revealed decreased sensation on the right side of the face and right upper and lower extremities and decreased motor power in the right upper and lower extremities. Contrast- enhanced magnetic resonance imaging of the brain revealed a 5.5 × 3-cm rim-enhancing mass in the left temporal lobe with surrounding oedema, with a mass effect and 4-mm mid- line shift to the right (Fig. 1). Twelve years earlier, the patient had a laryngeal carcinoma resected followed by chemotherapy and radiotherapy. The following year, he underwent a laryn- geal biopsy during which the airway was secured using awake fiberoptic intubation (FOI). The patient was scheduled for in- tracranial tumor resection under general anesthesia on a semi- urgent basis. Assessment revealed a modified Mallampati grade 3 airway, mouth opening of 2.5 cm, and thyromental ☆ Conflicts of Interest: None. ☆☆ Funding: None. ★ Institution: University of Mississippi Medical Center. ⁎ Corresponding author at: University of Mississippi Medical Center, 2500, N State St, Jackson, MS 39216. Tel.: +1 601 984 5900; fax: +1 601 984 5939. E-mail addresses: lkurnutala@umc.edu (L.N. Kurnutala), gurneet.sandhu@osumc.edu (G. Sandhu), Sergio.bergese@osumc.edu (S.D. Bergese). http://dx.doi.org/10.1016/j.jclinane.2016.05.023 0952-8180/© 2016 Elsevier Inc. All rights reserved. Journal of Clinical Anesthesia (2016) 34, 336–338