Airway management dilemma in a patient with carcinoma of the tongue and retrosternal goiter: a case report

Difficulty in intubation can be addressed if the otolaryngologist performs tracheostomy under local anesthesia. However, it becomes a dilemma when the tracheostomy is anticipated to be difficult due to the presence of retrosternal thyroid enlargement and when the procedure is requested to be done under general anesthesia. We performed airway management in a 72-year-old woman with double challenges of carcinoma of the left lateral border of the tongue and retrosternal thyroid enlargement for tracheostomy and gastrostomy under general anesthesia. We avoided oral intubation and anticipated potential obstructing airway, difficulty in ventilation, and potentially difficult tracheostomy, that limited the choice of our plan towards awake nasal intubation under monitored anesthesia care with dexmedetomidine and target-controlled infusion of remifentanil. Keywords: Carcinoma; Tongue; Thyroid; Intubation; Tracheostomy Citation: Alwyn Lee CY, Wan Hassan WMN, Mahamarowi NH, Azzeri AA. Airway management dilemma in a patient with carcinoma of the tongue and retrosternal goitre: a case report. Anaesth. pain intensive care 2025;29(2):362-365. DOI: 10.35975/apic.v29i2.2726 Received: October 10, 2024; Reviewed: October 16, 2024; Accepted: October 26, 2025