Confronting the immobile neck: Awake intubation in a complex cervical tumor airway – A case report

Rajan R, Raja SG

Pdf Page Numbers :- 31-34

Riddhi Rajan¹, and Soma Ganesh Raja^1,*

¹Department of Anaesthesiology and Pain Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai – 600116, Tamil Nadu, India

*Corresponding author: Dr. Soma Ganesh Raja, Associate Professor, Department of Anaesthesiology and Pain Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai – 600116, Tamil Nadu, India. Email: drsoms@gmail.com

Received 15 September 2025; Revised 30 October 2025; Accepted 13 November 2025; Published 24 November 2025

Citation: Rajan R, Raja SG. Confronting the immobile neck: Awake intubation in a complex cervical tumor airway – A case report. J Med Sci Res. 2026; 14(1):31-34. DOI: http://dx.doi.org/10.17727/JMSR.2026/14-6

Copyright: © 2026 Rajan R et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Recurrent fibromatosis of the neck is a rare, aggressive benign soft-tissue tumour that can cause extensive anatomical distortion, presenting significant anaesthetic challenges—particularly in airway management. We report the case of a 20-year-old male with recurrent cervical fibromatosis extending to the right shoulder, accompanied by severely restricted neck mobility and positional intolerance, including inability to lie supine. Awake fibreoptic intubation (AFOI) in the sitting position was planned and successfully executed using topical anaesthesia and dexmedetomidine sedation. Subsequent wide local excision with flap reconstruction was performed without complications. This case highlights the importance of individualized airway strategies and reinforces the role of AFOI in anatomically distorted, high-risk airway scenarios where conventional approaches are unsafe.

Keywords: awake fibreoptic intubation; cervical fibromatosis; difficult airway; dexmedetomidine; neck mass; sitting position