Base of Tongue Non-Hodgkin’s Lymphoma: Difficult Intubation

Primary Non-Hodgkin’s Lymphoma (NHL) of the tongue is a very rare tumor most commonly affecting elderly patients causing upper airway obstruction and anticipated difficult intubations with space occupying lesions that prevent tongue displacement and hence, scarce space for laryngoscopy. A 78-year-old man presented with progressive stridor and dyspnea. Oral examinations revealed tongue asymmetry and friable ulcerative lesions. During induction of anaesthesia in a scheduled partial glossectomy, difficult nasotracheal intubation was encountered despite using the Glidescope. Laryngeal landmarks could not be identified but successful nasotracheal intubation by hand-assisted and magill forceps manipulation of the endotracheal tube direction under video laryngoscopy. Failed intubation should always be considered in the management of base of tongue tumors. Pre-operative assessment and planning to secure the airway in patients presenting with base of tongue tumors decreases morbidity and mortality, especially when an emergency plan is prepared. No single airway management technique can be used for every patient. Further research is required for guiding the choice of airway management in such patients.