Cystic Hygroma with Difficult Airway in an Adult

Abstract

Cystic hygroma (CH) is an uncommon benign lesion usually occurring in the cervicofacial region and was first described by Wernher in 1943. It is commonly seen in neonates and in early infancy. CH is rare in adults with less than 150 adult cases with only few with difficult intubation have been reported in literature and 2-6% die of airway compromise. We report a rare case of CH in a 61-year-female occupying whole of oral cavity and extending to the neck, with feeding and breathing difficulty. This was classified as de Serres stage 5 and Mallampati grade IV. This case highlights that cystic hygroma be considered in the differential diagnosis of cystic neck masses in adults and considering the issue of difficult intubation, identification and appropriate plan for airway management is key to successful outcome. In this case surgical airway was on the cards, intubation by a skilled expert anesthetist using mackintosh laryngoscope made complete surgical removal through a trans cervical approach possible.