Difficult Airway Management in a Pediatric Patient with Parapharyngeal Mass: Case Report
,
Abstract
Critical airway incidents in children are among common anesthetic concerns. Due to limited apnea tolerance, any delay in airway management can quickly lead to severe complications. Unique pediatric anatomical features such as a large epiglottis, narrowed subglottic space, prominent occiput, elevated larynx position, and enlarged tongue can heighten the risk of airway obstruction. In this report, we presented a case of compromised airway due to a parapharyngeal mass in a 7-year-old patient, managed without complications.
[1] Olsen KD. Tumors and surgery of the parapharyngeal space. Laryngoscope. 1994;104:1-28.
[2] Bhardwaj A, Ps S, Sood R, Malhotra M, Priya M, Saikia R. Giant pediatric de novo parapharyngeal space pleomorphic adenoma: excision by semi trans-parotid cervical approach. Egypt J Otolaryngol. 2023;39(1):57.
[3] Marzouki H, Nujoom M, Fagih SN, Almokri RM, Zawawi F, Jamjoom R, et al. Surgical parapharyngeal space tumor analysis with case series study. Comput Intell Neurosci. 2022;2022(1):7083240.
[4] Arboleda LPA, de Mendonça RMH, Lopez EEM, Araújo ALD, Palmier NR, de Pauli Paglioni M, et al. Global frequency and distribution of head and neck cancer in pediatrics, a systematic review. Crit Rev Oncol Hemato. 2020;148:102892.
[5] Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1).
[6] Arboleda LPA, Hoffmann IL, Cardinalli IA, Santos Silva AR, de Mendonça RMH. Demographic and clinicopathologic distribution of head and neck malignant tumors in pediatric patients from a Brazilian population: a retrospective study. J Oral Pathol Med. 2018;47(7):696-705.
[7] Alli N, Meer S. Head and neck lymphomas: A 20-year review in an Oral Pathology Unit, Johannesburg, South Africa, a country with the highest global incidence of HIV/AIDS. Oral Oncol 2017;67:17-23.
[8] Varoquaux A, Fakhry N, Gabriel S, Garcia S, Ferretti A, Chondrogiannis S, et al. Retrostyloid parapharyngeal space tumors: a clinician and imaging perspective. Eur J Radiol 2013;82(5):773-82.
[9] Vogl TJ, Burck I, Stöver T, Helal R, editors. Parapharyngeal Space: Diagnostic Imaging and Intervention. In: RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. Georg Thieme Verlag KG; 2024.
[10] Grilli G, Suarez V, Muñoz MG, Costales M, Llorente JL. Parapharyngeal space primary tumours. Acta Otorrinolaringol (English Edition). 2017;68(3):138-44.
[11] Sichel J-Y, Eliashar R, Yatsiv I, Gomori JM, Nadjari M, Springer C, et al. A multidisciplinary team approach for management of a giant congenital cervical teratoma. Int J Pediatr Otorhinolaryngol. 2002;65(3):241-7.
[12] Shah SI, Holterman A-X, Licameli GR. Congenital cervical teratoma: airway management and complications. Otolaryngol Head Neck Surg. 2001;124(1):53-5.
[13] Cohen AF, Mitsudo S, Ruben RJ. Nasopharyngeal teratoma in the neonate. Int J Pediatr Otorhinolaryngo. 1987;14(2-3):187-95.
[14] Habre W, Disma N, Virag K, Becke K, Hansen TG, Jöhr M, et al. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med. 2017;5(5):412-25.
[15] Fiadjoe JE, Nishisaki A, Jagannathan N, Hunyady AI, Greenberg RS, Reynolds PI, et al. Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. Lancet Respir Med. 2016;4(1):37-48.
[16] Paterson N, Waterhouse P. Risk in pediatric anesthesia. Pediatr Anesth. 2011;21(8):848-57.
[17] Krishna SG, Bryant JF, Tobias JD. Management of the difficult airway in the pediatric patient. J Pediatr Intensive Care 2018;7(03):115-25.
[18] Khan SA, Matuszczak M. Management Of The Pediatric Difficult Airway: New Strategies Unveiled. Curr Anesthesiol Rep. 2024;14(3):417-25.
[19] Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2021;136(1):31-81.
[20] Stein ML, Argüello LAS, Staffa SJ, Heunis J, Egbuta C, Flynn SG, et al. Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time. EClinicalMedicine. 2024;69.
[21] Tamire T, Garbessa B, Gebeyehu G, Getachew L. Tracheal Intubation-related adverse events in pediatrics anesthesia in Ethiopia. Paediatr Anaesth. 2021; 31(5):515-521.
[22] Rizvanović N, Čaušević S, Šabanović A. Conditions of endotracheal intubation with and without muscle relaxant in children. Med Glasnik. 2017;14(1).
[23] Naziri F, Amiri HA, Rabiee M, Banihashem N, Nejad FM, Shirkhani Z, Solimanian S. Endotracheal intubation without muscle relaxants in children using remifentanil and propofol: Comparative study. Saudi J Anaesth. 2015;9(4):409-12.
[24] Karanth H, Raveendra U, Shetty RB, Shetty P, Thalanjeri P. Comparative evaluation between sevoflurane and propofol for endotracheal intubation without muscle relaxants in pediatric cleft surgeries. Anesth Essays Res. 2018;12(2):434-9.
[25] Karami T, Ghaffarizadeh F. Anesthesia management in a pediatric patient with Prune belly syndrome; a case report. Iranian Journal of Pediatric Surgery. 2022;8(2):173-8.
[26] Park R, Peyton J, Fiadjoe J, Hunyady A, Kimball T, Zurakowski D, et al. The efficacy of GlideScope® videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry. Br J Anaesth. 2017;119(5):984-92.
[27] Kulkarni KS, Karnik PP, Dave NM, Agrawal B. Radiological images through an anaesthesiologists' looking glass: Airway management in cervical lipomatosis in an infant. Indian J Anaesth. 2017;61(10):846-7.
[28] Villa EK, Samar NAS. An Innovative Airway Management of an Anticipated Difficult Airway in a Pediatric Patient with Cervical Cystic Hygroma: A Case Report. Acta Med Philipp. 2024;58(9):30-4.
[29] Pham CT, Nguyen HT, Le TA, Dang TD, Pham C, Nguyen HT. Parapharyngeal Space Ganglioneuroma in a Child: A Report of a Rare Case. Cureus. 2025;17(8).
[2] Bhardwaj A, Ps S, Sood R, Malhotra M, Priya M, Saikia R. Giant pediatric de novo parapharyngeal space pleomorphic adenoma: excision by semi trans-parotid cervical approach. Egypt J Otolaryngol. 2023;39(1):57.
[3] Marzouki H, Nujoom M, Fagih SN, Almokri RM, Zawawi F, Jamjoom R, et al. Surgical parapharyngeal space tumor analysis with case series study. Comput Intell Neurosci. 2022;2022(1):7083240.
[4] Arboleda LPA, de Mendonça RMH, Lopez EEM, Araújo ALD, Palmier NR, de Pauli Paglioni M, et al. Global frequency and distribution of head and neck cancer in pediatrics, a systematic review. Crit Rev Oncol Hemato. 2020;148:102892.
[5] Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1).
[6] Arboleda LPA, Hoffmann IL, Cardinalli IA, Santos Silva AR, de Mendonça RMH. Demographic and clinicopathologic distribution of head and neck malignant tumors in pediatric patients from a Brazilian population: a retrospective study. J Oral Pathol Med. 2018;47(7):696-705.
[7] Alli N, Meer S. Head and neck lymphomas: A 20-year review in an Oral Pathology Unit, Johannesburg, South Africa, a country with the highest global incidence of HIV/AIDS. Oral Oncol 2017;67:17-23.
[8] Varoquaux A, Fakhry N, Gabriel S, Garcia S, Ferretti A, Chondrogiannis S, et al. Retrostyloid parapharyngeal space tumors: a clinician and imaging perspective. Eur J Radiol 2013;82(5):773-82.
[9] Vogl TJ, Burck I, Stöver T, Helal R, editors. Parapharyngeal Space: Diagnostic Imaging and Intervention. In: RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. Georg Thieme Verlag KG; 2024.
[10] Grilli G, Suarez V, Muñoz MG, Costales M, Llorente JL. Parapharyngeal space primary tumours. Acta Otorrinolaringol (English Edition). 2017;68(3):138-44.
[11] Sichel J-Y, Eliashar R, Yatsiv I, Gomori JM, Nadjari M, Springer C, et al. A multidisciplinary team approach for management of a giant congenital cervical teratoma. Int J Pediatr Otorhinolaryngol. 2002;65(3):241-7.
[12] Shah SI, Holterman A-X, Licameli GR. Congenital cervical teratoma: airway management and complications. Otolaryngol Head Neck Surg. 2001;124(1):53-5.
[13] Cohen AF, Mitsudo S, Ruben RJ. Nasopharyngeal teratoma in the neonate. Int J Pediatr Otorhinolaryngo. 1987;14(2-3):187-95.
[14] Habre W, Disma N, Virag K, Becke K, Hansen TG, Jöhr M, et al. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med. 2017;5(5):412-25.
[15] Fiadjoe JE, Nishisaki A, Jagannathan N, Hunyady AI, Greenberg RS, Reynolds PI, et al. Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. Lancet Respir Med. 2016;4(1):37-48.
[16] Paterson N, Waterhouse P. Risk in pediatric anesthesia. Pediatr Anesth. 2011;21(8):848-57.
[17] Krishna SG, Bryant JF, Tobias JD. Management of the difficult airway in the pediatric patient. J Pediatr Intensive Care 2018;7(03):115-25.
[18] Khan SA, Matuszczak M. Management Of The Pediatric Difficult Airway: New Strategies Unveiled. Curr Anesthesiol Rep. 2024;14(3):417-25.
[19] Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2021;136(1):31-81.
[20] Stein ML, Argüello LAS, Staffa SJ, Heunis J, Egbuta C, Flynn SG, et al. Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time. EClinicalMedicine. 2024;69.
[21] Tamire T, Garbessa B, Gebeyehu G, Getachew L. Tracheal Intubation-related adverse events in pediatrics anesthesia in Ethiopia. Paediatr Anaesth. 2021; 31(5):515-521.
[22] Rizvanović N, Čaušević S, Šabanović A. Conditions of endotracheal intubation with and without muscle relaxant in children. Med Glasnik. 2017;14(1).
[23] Naziri F, Amiri HA, Rabiee M, Banihashem N, Nejad FM, Shirkhani Z, Solimanian S. Endotracheal intubation without muscle relaxants in children using remifentanil and propofol: Comparative study. Saudi J Anaesth. 2015;9(4):409-12.
[24] Karanth H, Raveendra U, Shetty RB, Shetty P, Thalanjeri P. Comparative evaluation between sevoflurane and propofol for endotracheal intubation without muscle relaxants in pediatric cleft surgeries. Anesth Essays Res. 2018;12(2):434-9.
[25] Karami T, Ghaffarizadeh F. Anesthesia management in a pediatric patient with Prune belly syndrome; a case report. Iranian Journal of Pediatric Surgery. 2022;8(2):173-8.
[26] Park R, Peyton J, Fiadjoe J, Hunyady A, Kimball T, Zurakowski D, et al. The efficacy of GlideScope® videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry. Br J Anaesth. 2017;119(5):984-92.
[27] Kulkarni KS, Karnik PP, Dave NM, Agrawal B. Radiological images through an anaesthesiologists' looking glass: Airway management in cervical lipomatosis in an infant. Indian J Anaesth. 2017;61(10):846-7.
[28] Villa EK, Samar NAS. An Innovative Airway Management of an Anticipated Difficult Airway in a Pediatric Patient with Cervical Cystic Hygroma: A Case Report. Acta Med Philipp. 2024;58(9):30-4.
[29] Pham CT, Nguyen HT, Le TA, Dang TD, Pham C, Nguyen HT. Parapharyngeal Space Ganglioneuroma in a Child: A Report of a Rare Case. Cureus. 2025;17(8).
| Files | ||
| Issue | Article in Press |
|
| Section | Case Report(s) | |
| Keywords | ||
| Case report Anesthesiology Airway management parapharyngeal mass | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Shahabi Shojaei F, Mahdavi N, Ahmadi H, Ebrahimsaraj G. Difficult Airway Management in a Pediatric Patient with Parapharyngeal Mass: Case Report. Arch Anesth & Crit Care. 2026;.
