Int J Anat Res 2015, 3(1):945-456. ISSN 2321-4287 945 Case Report
ASYM PTOM ATIC ABSENT EPIGLOTTIS
Vaibhav Shahi *
1, Dhananjay Kumar Singh
2.
ABSTRACT
Address for Correspondence: Dr. Vaibhav Shahi, Depart ment Of Anaest hesiology, Sri Guru Ram Rai Inst it ut e Of M edical Sciences & Healt h Sciences, Dehradun, Ut t arakhand, India.
E-M ail: vaibhavshahi@hot mail.com
Assist ant Professor * , Professor and Head 2.
Depar t m ent Of Anaest hesiology, Sri Guru Ram Rai Inst it ut e Of M edical Sciences & Healt h Sciences, Dehradun, Ut t arakhand, India.
Absence or hypoplasia of t he epiglott is is a rare anom aly. M ost pat ient s, w it h absent or hypoplast ic epiglott is, have present ed, life-t hreat ening sym pt om s of r espir at ory dist ress and sever e aspirat ion in inf ancy or early childhood. We report a case of com plet ely asym pt om at ic 30 year old fem ale w it h absent epiglot t is post ed for m odified radical m ast oidect om y for chronic suppur at ive ot it is m edia (CSOM ).
KEY W ORDS: Hypoplasia, Absent Epiglot t is, Aspirat ion, Respirat ory dist ress.
INTRODUCTION
Int ernat ional Journal of Anatomy and Research, Int J Anat Res 2015, Vol 3(1):945-46. ISSN 2321- 4287 DOI: ht t p:/ / dx.doi.org/10.16965/ ijar.2015.123
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Received: 20 Feb 2015 Accept ed: 05 M ar 2015 Peer Review : 20 Feb 2015 Published (O):31 M ar 2015 Revised: None Published (P):31 M ar 2015
Int ernat ional Journal of Anat omy and Research ISSN 2321-4287
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DOI: 10.16965/ ijar.2015.123
The funct ion of t he epiglot t is is t o prevent food and drink from falling dow n t he airw ay. The epiglot t is, a flap at t he base of t he t hr oat , t ouches t he back of t he t ongue and opens w hen sw allow ing occurs. It allow s food and drink t o safely pass int o our digest ive syst em. Failure of epiglot t is funct ioning result s in choking.
CASE REPORT
A 30 year old female pat ient w eighing 53 Kgs, w it hout any hist ory of aspirat ion, sleep apnea or dy sph agi a. The pat ient w as po st ed f or Chronic suppurat ive ot it is media (CSOM ) under gen er al anest hesi a. She w as t aken f o r anest h esia u n der ASA cl ass I. Her air w ay assessment w as M allampat i Grade I.
In t he op er at ing r oo m , w hen pat ient w as induced for general anest hesia w it h Propofol (2mg/ kg), Fentanyl (2mcg/ kg) and direct
laryn-goscopy w as at t empt ed for oral endot racheal int ubat ion w it h M acint osh laryngoscope w it h Vecuronium (0.1mg/ kg) as muscle relaxant . The epiglot t is w as found t o be absent (Figure 1). How ever, t he vocal cords w ere found normally below t he upper m argin of t he aryepiglot t ic folds. There w as no abnormalit y of head, neck or other organ systems. But t here w as sub glott ic st en osis as endo t r ach eal t ub e of in t er n al diamet er of 5.0 mm w as also negot iat ed w it h difficult y. General anaest hesia was maintained w i t h Oxygen and Nit r ous oxi de, Fen t any l, Vecuronium and Isof lorane. Neurom uscular r elaxant w as r ev er sed w i t h Neo st i gm i n e (0.05mg/ kg) w it h Glycopyrrolate (0.01mg/ kg).
Int J Anat Res 2015, 3(1):945-456. ISSN 2321-4287 946 Vaibhav Shahi , Dhananjay Kum ar Singh. ASYM PTOM ATIC ABSENT EPIGLOTTIS: A CASE REPORT.
Fig. 1: Absent epiglot t is, vocal cord in open posit ion. Fig. 2: Absent epiglot t is, vocal cord in closed posit ion.
DISCUSSION AND CONCLUSION
The epiglot t is, a flap at t he base of t he t hroat , t ouches t he back of t he t ongue and opens w hen sw allow ing occurs. It allow s food and drink t o safely pass int o our digest ive syst em. Failure of funct ioning of t he epiglot t is result s in choking.
Absence or hypoplasia of t he epiglot t is is a rare anomaly. Benjamin B et al[1] have reported t he f ir st in vivo phot ogr aph of t he hypoplast ic epiglot t is in an infant . Previously report ed cases eit her died short ly aft er birt h due t o mult iple congenit al anomalies or det ails of t he out come w ere lacking.
M o st o f t h e p at i en t s h avi n g h y p op l ast i c epiglot t is present w it h r epeat ed aspirat ion pneumonit is. Rizk HG et al [2] have report ed a case of a 26-m o n t h-o l d i n f an t w h o w as r ep eat ed l y t r eat ed f o r sever e asp ir at io n p n eu m o ni as t h at d i d n’ t r eso lv e w i t h gast rost omy.
M any pat ient s pr esent w it h a spect rum of sym pt om s like aspirat ion pneum onit is, OSA, h oar sen ess o f v o i ce, co u ghi n g d u r in g sw allow ing. Reyes BG et al [3] have report ed a case of 3 mont h old girl w it h congenit al absence of t he epiglottis present s w it h inspirat ory st ridor. Over t he next 8 years frank obst ruct ive sleep ap nea (OSA) d evel o p ed , co n f ir m ed b y polysom nograp hy. She has no d if f icult y in sw allow ing or phonat ion as assessed clinically and w it h barium swallow.
Hypoplasia of the epiglottis diagnosed at
adulthood is ext remely rare, as in our case. M ost p at i ent s w i t h ep i gl o t t i c hy p o pl asia h av e p r esen t ed li f e-t h r eat eni n g sy m pt o m s o f respirat ory dist ress and severe aspirat ion ininf ancy or ear ly chil dhood . Ro h JL [ 4] has r epo r t ed a case o f co n gen i t al ep i
-glottic hypoplasia found in a 42-year-old man
com plaining of m ild hoarseness and t hroat discomfort .Conflicts of Interests: None
REFERENCES
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