Customized Head Ring Positioning for Anesthetic Management of a Large Posterior Neck Lipoma: A Case Report

Background: Large posterior neck masses pose anesthetic challenges related to airway management and head positioning.Even when patients are able to lie supine, posterior cervical swellings may prevent neutral head positioning, resulting in an anticipated difficult airway.Case description: We report the anesthetic management of a 70-year-old male with a large posterior neck lipoma that had rapidly enlarged over the past year.Although the patient could lie supine, neutral head positioning was not possible due to the swelling.Imaging confirmed a large subcutaneous lipomatous lesion without deep tissue involvement.A customized enlarged head ring was fabricated to facilitate neutral supine head positioning.Modified rapid sequence induction was performed, and tracheal intubation was successfully achieved using video laryngoscopy.Surgery, extubation, and postoperative recovery were uneventful.Conclusion: Customized head ring positioning enabled safe airway management and successful anesthetic conduct in a patient with a large posterior neck lipoma.Clinical significance: Simple, patient-specific positioning modifications can enhance airway safety in patients with large posterior neck masses.