Laryngoscopy Complicated by Thyroid Cartilage Fracture

A 44-yr-old man with a thoracic aortic aneurysm presented for aortic arch grafting. He had a history of hypertension, alcohol abuse, smoking, and descending thoracic aortic aneurysm replacement 7 yr before this admission. There was no history of neck trauma, voice changes, difficulty swallowing, or respiratory problems. He was 6 feet (182 cm) tall and weighed 145 pounds (66 kg). His body mass index was 20 kg/m. After induction of general anesthesia, mask ventilation was easy. After paralysis with 60 mg rocuronium, laryngoscopy and intubation attempts with a Macintosh 3 blade, Miller 2 blade, stylet, and vigorous external laryngeal manipulation yielded only Cormack Lehane grade 3 views of the larynx. Adequate visualization of the larynx and intubation were achieved with a Glidescope (Verathon, Bothell, WA) and Glidescope Reusable Stylet (Verathon). External laryngeal manipulation was applied as forcefully as the assistant could perform the maneuver. The endotracheal tube and Glidescope Reusable Stylet were introduced beyond the vocal cords and into the larynx. After successful tracheal intubation, anesthesia and surgery progressed well. After the procedure, he was transferred to the intensive care unit, where he was extubated on postoperative day 3. Hoarseness was evident at that time and persisted to postoperative day 13. On day 13, computed tomography scan of the neck demonstrated a nondisplaced thyroid cartilage fracture (fig. 1). There was no significant laryngeal hematoma or arytenoid cartilage dislocation. The pharynx, base of tongue, floor of mouth, and trachea were all grossly normal. He was discharged on postoperative day 14.