Successful Airway Management with Combined Use of Glidescope® Videolaryngoscope and Fiberoptic Bronchoscope in a Patient with Cowden Syndrome

COWDEN syndrome is a rare autosomal dominant disorder caused by mutation in the phosphatase and tensin homolog gene.(1) It is characterized by multiple mucocutaneous hamartomas, malignancies of breast, thyroid, and genitourinary system, and a variety of intracranial abnormalities including meningiomas and vascular malformations.(2,3) Difficulties in airway management can be encountered in these patients because of the presence of papillomatous lesions on the mucosa of pharyngeal wall, lingual tonsils, and epiglottis.(4,5) In fact, critical airway obstruction and bleeding during induction of anesthesia requiring emergent tracheostomy has been described in association with Cowden syndrome.(5) We describe a case of successful airway management with combined use of a Glidescope (R) videolaryngoscope (Verathon Medical, Bothell, WA) and a fiberoptic bronchoscope in a patient with Cowden syndrome with papillomatous lesions of the airway.