• Savino Spadaro, Manuela D'Agata, Marco Verri, Riccardo Ragazzi, and Carlo A Volta.
• Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, S, Anna Hospital, University of Ferrara, via Aldo Moro 8 Cona, Ferrara, FE 44124, Italy. vlc@unife.it.
• BMC Res Notes. 2013 Jan 1;6:467.

BackgroundThe appropriate positioning of nerve integrity monitoring during thyroid surgery is of relevance. In this case report we describe our experience with accurate placement of a nerve integrity monitoring endotracheal tube, obtained by fiberoptic control, in a patient with expected difficult airway management.Case PresentationWe report the case of a 70-year-old obese woman scheduled for elective total thyroidectomy due to plunging intrathoracic goiter. The preoperative indirect laryngoscopy pointed out a massive bombè of the hypopharyngeal wall to the right and right vocal cord paralysis. The epiglottis was oedematous and the glottis could not be identified. On physical examination, the tongue was large and a Mallampati's score of 3 was determined. Hence, due to an expected difficult airway management, a nasal intubation with an electromyographic nerve integrity monitoring endotracheal tube trough fiberoptic bronchoscopy was successfully performed.ConclusionOur experience suggests that nasal intubation can be safely performed by using a nerve integrity monitoring tube with the help of fiberoptic bronchoscopy.

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