• Lenin Babu Elakkumanan, Anjolie Chhabra, Somnath Bose, and Kiran Sharma.
• Department of Anaesthesiology and Intensive care, All India Institute of Medical Sciences, New Delhi, India.
• Middle East J Anaesthesiol. 2010 Feb 1;20(4):573-6.

IntroductionIntubation with direct laryngoscopy may be impossible in 0.05%-0.35% patients due to an undetected supraglottic mass despite an apparently normal pre-operative airway assessment. We report a case of granular cell myoblastoma of the tongue, as a cause of an unanticipated impossible intubation.Case ReportA 55-year-old ASA III male weighing 75 Kg was taken up for emergency exploratory laparotomy with perforation peritonitis. On preoperative airway examination there was no indication of difficult intubation. After induction of anesthesia (rapid sequence with rocuronium) we performed direct laryngoscopy. There was a mass arising from the base of the tongue because of which no recognizable epiglottis or glottic structure could be identified. Despite repeat laryngoscopy, optimal external manipulation and direct laryngoscopy performed by an ENT surgeon, the airway could not be secured. As no fibreoptic laryngoscope was available, a surgical tracheostomy had to be performed.

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