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Awake Fiberoptic Intubation in a Patient with Severe Cervicofacial and Mediastinal Abscess: A Case Report
Author(s): Haijing Ren1*
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
Corresponding Author: Haijing Ren
Address: Department of Anesthesiology, West China Hospital, Sichuan University, No. 37, Guoxue Valley, Wuhou District, Chengdu 610041, Sichuan Province, China.
Received date: 27 June 2026; Accepted date: 08 July 2026; Published date: 15 July 2026
Citation: Ren H. Awake Fiberoptic Intubation in a Patient with Severe Cervicofacial and Mediastinal Abscess: A Case Report. Asp Biomed Clin Case Rep. 2026 Jul 15;9(2):125-29.
Copyright © 2026 Ren H. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Abstract
Introduction: Emergency surgical drainage is frequently required for patients with cervicofacial space infection complicated by a cervical abscess. Typical clinical manifestations include cervicofacial swelling, fever, local pain, and respiratory distress. Inflammatory airway edema and anatomical distortion commonly result in difficult intubation in these patients, posing a critical challenge for anesthesiologists. Formulating a safe and effective airway management strategy within a limited time window is essential.
Case Presentation: A 67-year-old male presented with an odontogenic cervicofacial space infection extending to the cervical region and mediastinum, requiring emergency abscess drainage. The patient presented with severe respiratory distress and hypoxemia (room-air SpO₂ 81%). Preoperative assessment confirmed a difficult airway. High-flow nasal oxygen (HFNO) preoxygenation was administered, followed by awake fiberoptic-guided nasotracheal intubation. The primary intraoperative challenges included insufficient topical anesthesia and difficulty in glottic exposure secondary to severe inflammatory swelling.
Conclusion: HFNO-assisted preoxygenation combined with awake fiberoptic-guided intubation successfully established a definitive airway in this critically ill patient, allowing the uneventful completion of emergency abscess drainage. This strategy provides a practical reference for airway management in similar severe clinical scenarios.
Keywords: Difficult Airway, High-Flow Nasal Oxygen, Fiberoptic Bronchoscopy, Awake Intubation, Cervicofacial Space Infection
Abstract
Introduction: Emergency surgical drainage is frequently required for patients with cervicofacial space infection complicated by a cervical abscess. Typical clinical manifestations include cervicofacial swelling, fever, local pain, and respiratory distress. Inflammatory airway edema and anatomical distortion commonly result in difficult intubation in these patients, posing a critical challenge for anesthesiologists. Formulating a safe and effective airway management strategy within a limited time window is essential.
Case Presentation: A 67-year-old male presented with an odontogenic cervicofacial space infection extending to the cervical region and mediastinum, requiring emergency abscess drainage. The patient presented with severe respiratory distress and hypoxemia (room-air SpO₂ 81%). Preoperative assessment confirmed a difficult airway. High-flow nasal oxygen (HFNO) preoxygenation was administered, followed by awake fiberoptic-guided nasotracheal intubation. The primary intraoperative challenges included insufficient topical anesthesia and difficulty in glottic exposure secondary to severe inflammatory swelling.
Conclusion: HFNO-assisted preoxygenation combined with awake fiberoptic-guided intubation successfully established a definitive airway in this critically ill patient, allowing the uneventful completion of emergency abscess drainage. This strategy provides a practical reference for airway management in similar severe clinical scenarios.
Keywords: Difficult Airway, High-Flow Nasal Oxygen, Fiberoptic Bronchoscopy, Awake Intubation, Cervicofacial Space Infection
Abstract
Introduction: Emergency surgical drainage is frequently required for patients with cervicofacial space infection complicated by a cervical abscess. Typical clinical manifestations include cervicofacial swelling, fever, local pain, and respiratory distress. Inflammatory airway edema and anatomical distortion commonly result in difficult intubation in these patients, posing a critical challenge for anesthesiologists. Formulating a safe and effective airway management strategy within a limited time window is essential.
Case Presentation: A 67-year-old male presented with an odontogenic cervicofacial space infection extending to the cervical region and mediastinum, requiring emergency abscess drainage. The patient presented with severe respiratory distress and hypoxemia (room-air SpO₂ 81%). Preoperative assessment confirmed a difficult airway. High-flow nasal oxygen (HFNO) preoxygenation was administered, followed by awake fiberoptic-guided nasotracheal intubation. The primary intraoperative challenges included insufficient topical anesthesia and difficulty in glottic exposure secondary to severe inflammatory swelling.
Conclusion: HFNO-assisted preoxygenation combined with awake fiberoptic-guided intubation successfully established a definitive airway in this critically ill patient, allowing the uneventful completion of emergency abscess drainage. This strategy provides a practical reference for airway management in similar severe clinical scenarios.