Intubação Orotraqueal num Doente com Tumor Facial e Via Aérea Difícil: Relato de Caso

Difficult airway management remains a major challenge in anesthesiology, particularly in patients with head and neck tumors. We report the case of a 22-year-old male patient. ASA II, with neurofibromatosis type I and an extensive facial tumor presented with significant anatomical distortion, limited mouth opening, and an anticipated difficult airway. Awake intubation with topical anesthesia and maintenance of spontaneous ventilation was planned. Despite adequate local anesthesia and good glottic visualization, the procedure was discontinued after three unsuccessful attempts due to intense nausea. A balanced anesthetic induction was then performed, with full preparation for airway failure. Orotracheal intubation using a videolaryngoscope and bougie was successfully achieved on the first attempt, without oxygen desaturation. The surgical procedure and extubation were uneventful. This case highlights the importance of thorough planning, flexibility in airway management strategies, and the use of advanced technologies to ensure safe management of the difficult airway.