Difficult Airway Management in A Patient With Penetrating Posterior Cervical Trauma : Successful C-Mac Videolaryngoscopic Intubation in the Lateral Position

Abstract

Background: Penetrating cervical trauma can present significant airway management challenges, particularly when a retained foreign body prevents conventional supine positioning. In such situations, securing the airway while avoiding displacement of the foreign body is essential.

Case Presentation: We report the case of a 45-year-old man admitted following penetrating posterior cervical trauma with a retained foreign body. On admission, he was conscious, hemodynamically and respiratorily stable, with no neurological deficit. Cervical computed tomography with three-dimensional reconstruction showed the retained object without major vascular or spinal cord injury. Because supine positioning could have displaced the foreign body and aggravated the cervical injury, the patient was maintained in the lateral decubitus position for airway management. After standard monitoring and preoxygenation, general anesthesia was induced with midazolam, propofol, and a neuromuscular blocking agent. Tracheal intubation was performed using a C-MAC videolaryngoscope in the lateral position. Successful intubation was achieved after two attempts. The endotracheal tube was secured, followed by controlled surgical removal of the foreign body, wound exploration, and drainage. The anesthetic course remained uncomplicated, with stable respiratory and hemodynamic parameters. The patient was extubated immediately after surgery without respiratory or neurological complications. Conclusion:Lateral-position videolaryngoscopic intubation can provide an effective airway management strategy when conventional supine positioning is contraindicated or technically impossible because of penetrating cervical trauma. This case highlights the importance of individualized airway planning, careful avoidance of foreign-body manipulation, multidisciplinary coordination, and preparation for alternative airway strategies.