Case Report of an open Neck Procedure Complication Associated with Laryngeal Mask Airway Use

Document Type: Case Report


Department of Otolaryngology-Head and Neck Surgery, St James Hospital, Dublin. Ireland.


The laryngeal mask airway (LMA) is a safe method to establish airway control during general anaesthesia. In otolaryngology surgery, the use of a LMA is well established in ear surgery; however, the use of a LMA during open neck procedures remains controversial. We report a case in which the pharyngeal distortion by the LMA cuff resulted in an iatrogenic complication.
Case Report:
A 38-year-old female with a background of multiple myeloma was referred to the otolaryngology team for an open cervical lymph node biopsy. The patient was in remission after a 2 year post chemotherapy treatment, but now presented with a 4-week history of persistent nodal enlargement. During the elective procedure, pharyngeal distortion from the laryngeal airway mask used for airway management resulted in an iatrogenic pharyngeal injury. This case is reported to highlight the importance of communication between the surgeon and anesthetist about the mode of airway management in open neck surgery.
Communication between the otolaryngologist and anesthetist is pertinent when selecting the method of airway management in open neck procedures. A LMA should be used with caution during open neck procedures, with the surgeon recognizing the potential for pharyngeal distortion.


Main Subjects

1. A. I. J. BRAIN. The laryngeal mask-a new concept in airway management. British Journal of Anaesthesia 1983;55(8):801-6.

2. Jefferson N, Riffat F, McGuinness J, Johnstone C. The laryngeal mask airway and otorhinolaryngology head and neck surgery. The Laryngoscope. 2011;121(8):1620-6.

3. Taheri A, Hajimohamadi F, Soltanghoraee H, Moin A. Complications of using laryngeal mask airway during anaesthesia in patients undergoing major ear surgery. Acta otorhinolaryngologica Italica 2009;29(3):151-5.

4. Brimacombe JR, Keller C, Gunkel AR, Puhringer F. The influence of the tonsillar gag on efficacy of seal, anatomic position, airway patency, and airway protection with the flexible laryngeal mask airway: a randomized, cross-over study of fresh adult cadavers.Anesthesia and analgesia1999;89(1):181-6.

5. Endo K, Okabe Y, Maruyama Y, Tsukatani T, Furukawa M. Bilateral vocal cord paralysis caused by laryngeal mask airway. American journal of otolaryngology. 2007;28(2):126-9.

6. van der Woerd B, Robichaud J, Gupta M. Parapharyngeal abscess following use of a laryngeal mask airway during open revision septorhinoplasty. International journal of surgery case reports. 2015; 16:198-201.

7. Lynn E, Ping T, Keng Y, Singh R, Kwong W, Soon T, et al. Retropharyngeal abscess - A complication of laryngeal mask airway. Journal of surgical case reports. 2012;2012(10):7.

8. Hooda S, Gupta SK. Acute transient sialadeno- pathy associated with laryngeal mask airway. Anesthesia and analgesia 1998;87(6):1438-40.

9. Ulusoy H, Besir A, Cekic B, Kosucu M, Geze S. Transient unilateral combined paresis of the hypoglossal nerve and lingual nerve following intubation anesthesia. Brazilian journal of anesthesiology (Elsevier). 2014;64(2):124-7.

10. Thiruvenkatarajan V, Van Wijk RM, Elhalawani I, Barnes AM. Lingual nerve neuropraxia following use of the Laryngeal Mask Airway Supreme. Journal of clinical anesthesia. 2014;26(1):65-8.

11. Fideler FJ, Schroeder TH. Cranial nerve injuries from a laryngeal mask airway. European journal of anaesthesiology. 2009;26(11):980-1.

12. Samuels PJ, Striker TW. Spurious diagnosis of a cervical mass due to a laryngeal mask airway. International journal of pediatric otorhinolaryn- gology. 1999;48(3):265-6.