2025, Vol. 8, Issue 4, Part A

Background: Tracheal intubation is the gold standard for securing the airway and is a core skill for every anaesthetist. While typically performed after induction of anaesthesia, certain clinical scenarios such as deep neck infections or abscesses with airway distortion necessitate an awake approach. Untreated odontogenic infections may extend into deep neck spaces such as the submandibular or submental region, causing trismus, tissue oedema, and restricted airway access, making conventional intubation risky due to potential abscess rupture and aspiration.
Objectives: To present a case of successful airway management in a patient with a submandibular abscess using awake fibreoptic intubation and to emphasize its value as a safe and effective approach for anticipated difficult airways.
Methodology: A 46-year-old female presented with fever, progressive facial swelling, trismus, and dysphagia for one week. Preoperative airway assessment revealed restricted mouth opening (2 cm), short neck, and limited extension. Under conscious sedation and airway blocks, nasal fibreoptic bronchoscope-guided intubation was performed with 7.0 mm flexometallic endotracheal tube after adequate topical anaesthesia using lignocaine and oxymetazoline for nasal decongestion. General anaesthesia was maintained with O?, N?O, sevoflurane, and atracurium.
Results: The patient was successfully intubated with minimal discomfort, and surgery for incision and drainage was completed uneventfully. Postoperative recovery was smooth with no evidence of airway trauma, aspiration, or stridor.
Conclusion: Awake fibreoptic intubation remains the gold standard technique for managing patients with anticipated difficult airways, especially in cases of deep neck infections. Proper preoperative preparation, adequate topical anaesthesia, effective communication, and teamwork are essential for ensuring patient safety and optimal outcomes.