Unanticipated Difficult Intubation in a Child Due to a Vallecular Cyst: A Case Report

Vallecular cysts are rare mucous-retention lesions that can cause potentially fatal airway obstruction during anesthesia while remaining clinically silent. We describe the case of a five-year-old girl who was scheduled for orthopedic surgery and experienced an unexpectedly challenging intubation as a result of an undetected vallecular cyst. A cystic mass blocking the laryngeal inlet was discovered by direct laryngoscopy, but mask ventilation was still effective. Visualization was enhanced by videolaryngoscopy, and a bougie-guided endotracheal intubation was successful. Airway anatomy was restored by aspirating a vallecular cyst that was discovered during intraoperative ENT evaluation, and the patient was extubated successfully. Later, definitive marsupialization was performed before planned orthopedic surgery, and this time, the intubation was smooth. This case highlights the possibility that vallecular cysts could make supraglottic devices unsuitable, necessitating the use of videolaryngoscopy, fibreoptic techniques, or early surgical backup.