Ismail Jainulabedin Namazi1, Shwetha K. M2, Suyash Prasad3, Arun Rudrappa Malager4
PRESENTATION OF CASE A 65-year-old male patient came with 6 months history of swelling over the right side of neck, which was gradually increasing in size.
CLINICAL DIAGNOSIS A 65-year-old male patient came with 6 months history of swelling over the right side of neck, which was gradually increasing in size. Examination revealed a firm nontender submandibular mass of 10 x 7 cms in size with intraoral extension pushing the uvula to left and obscuring the posterior pharyngeal wall. Routine blood investigations were normal. The contrast enhanced computed tomography revealed a well-defined mass lesion of size 7.5 x 4.1 x 5 cm in the right submandibular region involving the gland, which was showing multiple calcifications predominantly in periphery with heterogeneous contrast enhancement noted on delayed scans. The lesion was noted compressing the airway medially obliterating the parapharyngeal spaces and recess. Excision biopsy of the swelling was planned and the patient was sent for preanaesthetic checkup. General physical examination was unremarkable. Airway assessment revealed Mallampati grade 2, 3 fingerbreadth mouth opening, thyromental distance of 7 cms and the neck movements were normal. Bilateral nares were patent with no deviated nasal septum. We planned to perform fibreoptic guided awake nasotracheal intubation followed by General Anaesthesia (GA).