Glottic narrowing secondary to prior mosquito repellent ingestion presenting as a difficult airway during craniovertebral junction surgery

Airway involvement following chemical ingestion is rare but may pose life-threatening challenges to the anaesthesiologist. We report an Asian woman, in her 50s, with craniovertebral junction anomaly scheduled for posterior instrumentation comprising occiput-bilateral C1-C2 laminar screw and rod fixation along with foramen magnum decompression. Intraoperatively, she developed unexpected glottic narrowing which was later attributed to prior mosquito repellent ingestion which posed significant airway challenges. Initial intubation was uneventful with a video laryngoscope; however, attempts at tracheal extubation and re-intubation failed due to unrecognised airway narrowing and severe glottic oedema. Multiple attempts with smaller endotracheal tubes were unsuccessful, necessitating an emergency tracheostomy to secure the airway. Retrospective evaluation revealed a missed history of caustic ingestion and subtle tracheal narrowing on chest radiograph. This case underscores the compounded risks of airway management in patients with cervical spine anomalies and prior corrosive ingestion. Vigilant history-taking, careful review of preoperative imaging, availability of smaller tubes and readiness for surgical airway are paramount.