A 78-year-old man presented with stridor and dysphonia after choking at home. He deteriorated, with respiratory distress and an oxygen saturation of 55% despite oxygen via a non-rebreather mask. Flexible nasendoscopy demonstrated a food bolus between the epiglottis and glottis. The team judged apnoea and assisted positive-pressure ventilation before extraction to be hazardous, while deterioration and limited cooperation made an awake technique impracticable. Sole-agent ketamine sedation facilitated videolaryngoscopy with clinically observed spontaneous breathing; the bolus, a slice of carrot, was removed using Magill forceps. Rocuronium was then administered and an attempt at tracheal intubation prior to its onset was unsuccessful. As rocuronium took effect, the laryngoscopic view improved and copious blood-stained tracheal fluid appeared. Following suction, the trachea was intubated. Negative-pressure pulmonary oedema was suspected. His lungs were ventilated for 48 h, and he was subsequently discharged home without sequelae. The case illustrates staged foreign body removal and subsequent tracheal intubation, with preparation for neuromuscular blockade and airway rescue. In this patient, ketamine facilitated laryngoscopy and foreign body removal while spontaneous breathing was clinically observed.

SARS-CoV-2 infection in children is typically mild, although COVID-19-associated croup can be severe. We report a patient in middle childhood with impending critical airway obstruction due to severe subglottic oedema and extensive inflammatory slough/crusting following SARS-CoV-2 infection. Subsequent airway assessment in the operating theatre revealed critical subglottic narrowing. During transport, nebulised epinephrine was initiated; however, the patient developed hypoxaemia (SpO2 80%) with loss of consciousness. On arrival, video-laryngoscopic removal of obstructive slough using Magill forceps and Yankauer suction restored spontaneous ventilation with forceful expectoration of residual debris. Because of persistent severe oedema, endotracheal intubation required a markedly undersized tube for the patient's predicted size (internal diameter 4.5 mm). Following unplanned self-extubation on day 1, residual subglottic oedema and slough were managed with nebulised epinephrine and dexamethasone without re-intubation. The patient was discharged on day 10 without complications. This case highlights the importance of definitive airway management in a controlled setting.

Foreign body ingestion is a common pediatric emergency, and coins are among the most frequently ingested objects. When a coin becomes lodged at the pharyngoesophageal junction, prompt removal is required to avoid perforation, mucosal injury, and airway compromise. We report the case of a five-year-old boy with a coin impacted in the upper esophagus at the level of the cricopharyngeus, successfully removed under general anesthesia using a video laryngoscope and Magill forceps without major complications. This case highlights two key educational points. First, the use of a video laryngoscope allowed the operator and supervisor to share the same view in real time, enabling immediate intraoperative guidance. Second, a structured pre-procedural briefing appeared to enhance intraoperative team performance, and a post-procedural debriefing appeared to reinforce learning outcomes. This case suggests that a structured educational approach, combined with shared visualization, may facilitate both safe management and effective teaching of infrequently performed procedures.

Dental dislodgement during oral and maxillofacial surgery is an uncommon, but potentially serious complication. We report a case of intraoperative tooth loss with asymptomatic supraglottic retention during oral surgery under general anesthesia. A 55-year-old man underwent bilateral maxillary endoscopic sinus surgery (MESS) under general anesthesia. A severely mobile mandibular tooth was missing during surgery, although the ventilation and hemodynamic parameters remained stable. As the patient showed no evidence of airway compromise and the location of the tooth was uncertain, radiographic localization was performed after completion of the procedure. Portable radiograph revealed a tooth-shaped foreign body in the laryngeal region. Subsequent videolaryngoscopic examination revealed a tooth lodged beneath the epiglottis and above the vocal cord. The tooth was successfully removed using Magill forceps and the patient recovered without any respiratory complications. This case highlights that a dislodged tooth may remain undetected in the supraglottic airway despite stable respiratory parameters. Radiographic localization, followed by targeted video laryngoscopic retrieval, has enabled successful management.

Dental trauma is a recognized complication of airway management during general anesthesia, particularly in patients with poor dentition. Dislodged teeth pose a significant risk of airway obstruction, aspiration, and subsequent pulmonary complications, with important medico-legal implications. We report the case of a 45-year-old male with multiple loose and missing teeth, scheduled for an uncemented bipolar hemiarthroplasty under general anesthesia following a polytrauma incident one week prior. Despite appropriate preoperative counseling and informed consent, a dental injury occurred during direct laryngoscopy. An upper central incisor fractured and was immediately retrieved. Subsequently, an upper lateral incisor became dislodged and could not be located on the initial laryngoscopic examination or the intraoperative chest X-ray. Systematic reassessment, including thorough suctioning and repeat airway inspection, revealed the tooth lodged in the pyriform fossa, which was successfully retrieved using Magill's forceps. The patient remained hemodynamically stable throughout, with no evidence of aspiration or postoperative complications. Dental injuries during anesthesia are multifactorial and more common in patients with pre-existing dental pathology. This report highlights the importance of a meticulous preoperative dental assessment, clear risk communication, and thorough documentation. It also underscores the need for a structured, persistent approach to locating and retrieving dislodged teeth, as they may not always be detectable on radiographic imaging. Iatrogenic dental trauma during airway management can be effectively managed with prompt recognition, systematic evaluation, and timely retrieval. Preventive strategies, careful airway handling, and adherence to a structured retrieval protocol are essential to minimize complications and medico-legal risk.

Background/Objectives: Pediatric nasotracheal intubation may remain difficult at the stage of glottic alignment and laryngeal entry even after passage through the nasal cavity. We aimed to describe the distribution of adjunctive maneuvers required for glottic entry during pediatric nasotracheal intubation and to explore factors associated with their use. Methods: We conducted a prospective observational cohort study of 54 children undergoing dental surgery requiring nasotracheal intubation. Glottic-entry maneuvers were categorized as direct passage, cuff inflation assistance, or Magill forceps assistance. Baseline characteristics, perioperative variables, tube size selection, tube downsizing, and bleeding grade were compared among groups. Univariable and multivariable logistic regression analyses were performed for the primary outcome, defined as the need for any adjunctive maneuver. Results: Glottic entry was achieved by direct passage in 34 patients, required cuff inflation assistance in 15, and required Magill forceps assistance in 5. Baseline characteristics were broadly similar across groups, although sex distribution, body weight, and preoperative respiratory rate differed significantly. Anesthesia duration, surgery duration, bleeding grade, initial tube size, tube downsizing, and final tube size did not differ significantly among groups. In univariable logistic regression, female sex showed a borderline association with the need for any adjunctive maneuver, whereas age and initial tube size were not significant. In multivariable analysis, no stable independent predictor was identified. Conclusions: Most children achieved glottic entry by direct passage, whereas a minority required cuff inflation assistance or Magill forceps assistance. These prospective data provide a practical stepwise description of glottic-entry assistance during pediatric nasotracheal intubation.

Leech infestation of the upper airway is an uncommon but potentially life-threatening condition, especially among children living in rural areas with limited access to safe drinking water. Early recognition and intervention are crucial to prevent severe complications such as airway obstruction and profound anemia. We present the case of an 8-year-old boy from rural North Gondar, Ethiopia, who arrived at our facility with a 5-day history of coughing up blood, blood-stained saliva, hoarseness, throat discomfort, and progressive respiratory distress. On examination, he was acutely ill, severely anemic (hemoglobin 4.0 g/dL), and in hypovolemic shock. A dark, mobile foreign body was visualized in the oropharynx. Due to the unavailability of laryngoscopy, the leech was manually extracted with MaGill forceps at the bedside. The patient received blood transfusions and antibiotics, resulting in rapid clinical improvement and an uneventful recovery. Oropharyngeal and laryngeal leech infestations, while rare, are important considerations in children from endemic regions presenting with unexplained upper airway symptoms and anemia. The parasite's anticoagulant and anesthetic secretions can delay symptom onset and diagnosis, increasing the risk of morbidity. Limited resources often hinder optimal management, but prompt recognition and removal of the leech are essential for a favorable outcome. This case highlights the importance of heightened clinical awareness of leech infestations in at-risk populations. Public health measures to improve water, sanitation, and community education are vital to prevent future cases in resource-limited settings.