Lingual Thyroid - Is awake Fibreoptic Intubation Ideal?

Lingual thyroid is a rare developmental anomaly, resulting from failure in the descent of the thyroid tissue. Airway management of such patients is challenging due to the presence of the vascular, fragile mass in the midline on the dorsum of the tongue with inherent risk of bleeding on touch and possible rapid deterioration in the chances of securing the airway once the bleeding starts. Preoperative airway assessment, adequate planning and preparedness, expertise can prevent catastrophic complications. Despite patient co-operation, presence of expertised personnel, unique challenges can arise on an individual case to case basis. Presence of mind and institution of novel combined manoeuvres depending upon the need of the hour can aid in overcoming the obstacles and ensuring successful outcome.