Newly Published
Images in Anesthesiology  |   January 2020
Forestier Disease and Airway Management
Author Notes
  • From the Department of Anesthesiology, Kameda Medical Center, Kamogawa City, Chiba, Japan.
  • Correspondence: Address correspondence to Dr. Sugiyama: sugiyama.daisuke@kameda.jp
Article Information
Images in Anesthesiology / Airway Management
Images in Anesthesiology   |   January 2020
Forestier Disease and Airway Management
Anesthesiology Newly Published on January 13, 2020. doi:https://doi.org/10.1097/ALN.0000000000003136
Anesthesiology Newly Published on January 13, 2020. doi:https://doi.org/10.1097/ALN.0000000000003136
Forestier disease or diffuse idiopathic skeletal hyperostosis is a noninflammatory disease characterized by the presence of anterior bridging osteophytes that spare the disc and joint space of unknown etiology in elderly men, mostly at thoracic levels and asymptomatic in some cases.1–3  Spine x-ray in patients with Forestier disease shows normal bone density and the presence of extensive ossification of anterior longitudinal ligament, with bridging osteophytes in the anterior cervical and upper thoracic spine.1–3 
The accompanying images show a large tumor-like bulge of the posterior hypopharynx wall which, together with the epiglottis, completely obstructed the upper airway during the initial laryngoscopy with McGrath MAC (Medtronic, USA). With careful external laryngeal manipulation and increased force in laryngoscopy, the laryngeal view was significantly improved, which allowed endotracheal intubation. The finding was consistent with preoperative sagittal cervical spine computed tomography, which showed C3–C5 hyperostosis producing anterior laryngopharyngeal displacement, with obstruction of the airway around the epiglottis (red arrow).