Misguidance of peroral rigid laryngoscopy in assessment of difficult airway: two comparable cases in microlaryngeal surgery.

We describe two patients with laryngeal cyst who underwent microlaryngeal surgery. Peroral rigid laryngoscopy, as an indirect endoscopy, performed via the transoral route, was evaluated as a routine screening tool of the difficult airway in patients with laryngeal neoplasm, in our hospital preoperatively. Peroral rigid laryngoscopy had led to two different procedures: One patient was misdiagnosed as having a difficult airway by the ear, nose and throat surgeon resulting in an unnecessary awake tracheotomy. The other patient was found to be with an unanticipated difficult intubation following routine anaesthesia, successful on the third attempt. As we saw in these two cases, endoscopic examination alone was inadequate for the assessment of a difficult airway, which may also lack the predictive sensitivity or may cause a high false positive. Usage of video laryngoscopy combined with intubating stylet will improve the intubation success in patients with huge epiglottic cyst.