Advanced, Organ-Based and Clinical Sciences
• Mandible: Macrognathia
• Connective tissue: Recurrent laryngeal nerve paralysis caused by stretching of tissues as cartilaginous structures in the neck expand, leading to abnormal VC movement.
• Vocal cords: Chondrocalcinosis of larynx leads to VC thickening and stricture formation. Cricoarytenoid joint involvement may cause impaired movement of the VC.
Airway Management: In general, consider using a larger blade for DL, as the distance between the lips and VC will be increased by macrognathia. Videolaryngoscopy may be useful if large tongue and epiglottis impede the line of vision. Consider using a smaller ETT due to possible narrowing of the cricothyroid ring and glottic opening. If patient has evidence of OSA, consider fully awake extubation.