Tracheal Intubation in A Patient with Breast Cancer Complicated with Maxillofacial Bone Metastasis and Bone Destruction

We report the tracheal intubation of a 51-year-old woman with maxillofacial bone metastasis and bone destruction following surgery for breast cancer. The patient had previously undergone radical surgery for left breast cancer and was currently experiencing complications, including bone destruction and pus discharge in the left maxillofacial region. Due to the inability to eat orally and the failure of multiple nasogastric tube placements, it was decided, after multi-department consultation, to perform a jejunostomy under general anesthesia and place a jejunal nutrition tube. Preoperative head and neck CT showed that most of the mandible was missing, there was bilateral maxillofacial and neck soft tissue swelling, and bilateral nasal stenosis. The preoperative anesthesia evaluation indicated that the patient would likely have difficulties with mask ventilation, nasal intubation, and oral laryngoscopy placement. Since conventional anesthesia methods for airway establishment through the mouth or nose were not feasible, spontaneous breathing was maintained in the awake state, and endotracheal intubation was performed under combined tracheal surface anesthesia with basic sedation and analgesia. The patient cooperated well during the intubation process. After the operation, the endotracheal tube was removed, and the patient was returned to the ward.