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Education  |   November 2017
Lingual Thyroid
Author Notes
  • From the Departments of Anesthesiology (B.K.B., S.M.) and Ear, Nose, and Throat (P.K.P.), All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
  • Address correspondence to Dr. Misra: misrasatyajeet@gmail.com
Article Information
Education / Images in Anesthesiology / Pediatric Anesthesia
Education   |   November 2017
Lingual Thyroid
Anesthesiology 11 2017, Vol.127, 891. doi:10.1097/ALN.0000000000001743
Anesthesiology 11 2017, Vol.127, 891. doi:10.1097/ALN.0000000000001743
A 32-yr-old woman presented to the anesthetic clinic for preoperative evaluation for excision of a lingual thyroid. The pink mass was seen in the midline at the base of tongue and partly covered with yellow slough (Panel A). Contrast computed tomography showed the well-defined homogenously enhancing mass (black arrow) at the base of tongue (Panels B and C). The mass was not encroaching on the epiglottis (white arrow), and there was no evidence of airway obstruction.
Lingual thyroid is a rare developmental anomaly and results from failure in descent of the thyroid gland from the foramen cecum to its normal prelaryngeal site.1  The prevalence is 1:100,000 to 1:300,000 with a female:male ratio of 4:1.1 
There are no predictors of a difficult airway in patients with midline lingual masses, and oral examination may not reveal any abnormality, especially with more posteriorly located masses.2  Asymptomatic patients may present with difficulty in mask ventilation and/or intubation due to pressure effects of the mass on the epiglottis.2  Oral airway insertion to prevent tongue collapse after anesthesia induction or direct laryngoscopy and oral intubation may result in significant bleeding due to trauma to the glandular tissue.1 
In this case, we have planned to secure the airway with awake flexible bronchoscopy.3  In patients presenting with difficult airway due to undiagnosed lingual masses, video-assisted, laryngoscopy-guided intubation is an option and may be better than a laryngeal mask airway or flexible bronchoscopy because it is a visually guided procedure and the vallecula can be mechanically lifted to visualize the glottis.
Competing Interests
The authors declare no competing interests.
References
Buckland, RW, Pedley, J . Lingual thyroid: A threat to the airway. Anaesthesia 2000; 55:1103–5 [Article] [PubMed]
Ovassapian, A, Glassenberg, R, Randel, GI, Klock, A, Mesnick, PS, Klafta, JM . The unexpected difficult airway and lingual tonsil hyperplasia: A case series and a review of the literature. Anesthesiology 2002; 97:124–32 [Article] [PubMed]
Apfelbaum, JL, Hagberg, CA, Caplan, RA, Blitt, CD, Connis, RT, Nickinovich, DG, Hagberg, CA, Caplan, RA, Benumof, JL, Berry, FA, Blitt, CD, Bode, RH, Cheney, FW, Connis, RT, Guidry, OF, Nickinovich, DG, Ovassapian, A ; American Society of Anesthesiologists Task Force on Management of the Difficult Airway: Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; 118:251–70 [Article] [PubMed]