Preoperative airway assessment is built on questions and measurements: neck movement, mouth opening, jaw size, snoring, hoarseness, difficulty swallowing. A 60-year-old woman admitted with gallstones and cholecystitis, scheduled for laparoscopic gallbladder removal, cleared all of it. She had no complaints pointing to her throat.
Then the anesthetic went in. Mask ventilation became difficult, and video laryngoscopy showed why: a huge cyst on her epiglottis, obscuring the glottis, the opening between the vocal cords that a breathing tube has to pass through. The first intubation attempt failed.
