Difficult Intubation in Pediatric Due to Vocal Cord Granuloma: A Case Report

Vocal cord granuloma (VCG) is a benign laryngeal lesion. Common causes in adult are prolonged intubation or irritation as well as injury to vocal cord. In term of airway management, VCGs may lead to difficult intubation. We reported a case scenario of VCG during rapid sequence induction. A 4-month-old baby girl, with a diagnosis of recurrent diaphragmatic hernia. She was intubated for impending respiratory collapse prior to operation. Successful intubation with smaller endotracheal tube (ETT) size 3Fr with stylet at 3rd attempts by pediatric intensivist. Direct laryngoscope was done post operation. Finding was granuloma noted over the both posterior commissures. In the present case, the 4-month-old baby had no sign and symptom of vocal cord granuloma. However, she was at risk of develop VCG in view of the history of intubation for first operation of diaphragmatic hernia and possibility of laryngopharyngeal reflux due to the hernia. Difficult airway should be anticipated in this patient in view of the history of intubation and laryngopharyngeal reflux.