# Radiation-Induced Nasopharyngeal Fibrosis Resulting in a Difficult Airway: A Case Report

## TL;DR

This case report describes a patient with a difficult airway caused by radiation-induced fibrosis after nasopharyngeal cancer treatment.

## Contribution

The report highlights the risk of difficult airway due to radiation-induced fibrosis in head and neck cancer survivors.

## Key findings

- An 83-year-old woman with a history of nasopharyngeal cancer developed a difficult airway after radiotherapy.
- Radiation-induced fibrosis caused trismus, limited neck movement, and airway visualization challenges.
- Fiberoptic bronchoscopy was necessary for successful intubation in this case.

## Abstract

Patients with head and neck cancer often experience airway complications. This case highlights a patient with nasopharyngeal cancer post-radiotherapy (RT), who presented with a difficult airway (DA). An 83-year-old woman, scheduled for a partial left lower lobe pneumonectomy, had received RT for nasopharyngeal cancer one year prior. Physical examination revealed trismus, limited neck movement, Mallampati class IV, and grade III on the upper lip bite test. Bronchoscopy showed mucous membrane irregularities in the nasopharynx, along with an edematous epiglottis and vocal cords. After general anesthesia induction, both mask ventilation and McGrath™ intubation (Covidien Inc., Tokyo, Japan) attempts failed. Lifting the patient's tongue manually allowed visualization of the vocal cords via a fiberoptic bronchoscope, enabling successful intubation. Patients who have undergone head and neck radiotherapy (HNRT) are at increased risk of DAs due to radiation-induced fibrosis (RIF) of pharyngeal soft tissues.