Acute Tumour Haemorrhage During Airway Instrumentation in a Patient With an Extensive Tongue Base and Oropharyngeal Tumour: A Case Report

A 57-year-old female with a history of moderately differentiated keratinising squamous cell carcinoma of the anal canal presented with weight loss, dysphagia, odynophagia, right-sided otalgia, and a gradually growing right-sided neck lump.Flexible nasendoscopy and clinical examination revealed anomalies related to the tonsillar fossa and base of the right tongue.A massive necrotic tumour that crossed the midline and was centred on the right oropharynx and tongue base was seen on contrast-enhanced computed tomography of the neck, along with bilateral cervical lymphadenopathy.In addition to bilateral necrotic cervical lymphadenopathy and right-sided perinodal spread, further magnetic resonance imaging revealed widespread local tumour involvement of the tongue, tongue base, tonsillar pillar, pre-epiglottic fat, prevertebral soft tissues, and pterygoid muscles.The disease was radiologically staged as T4 N3B with extranodal extension.During general anaesthesia for an examination under anaesthesia of the rectum, airway instrumentation resulted in significant bleeding from the previously identified oropharyngeal tumour, requiring urgent ENT intervention for haemostasis and tissue sampling.The patient was subsequently reviewed by the head and neck cancer multidisciplinary team.The combination of extensive upper aerodigestive tract disease, anticipated difficult airway, and tumour-related haemorrhage presented significant diagnostic and perioperative challenges.The patient's previous anal squamous cell carcinoma also created an important diagnostic consideration regarding the origin of the new malignancy.This case highlights the potential for extensive oropharyngeal tumours to cause significant haemorrhage during airway instrumentation and emphasises the importance of careful airway assessment, multidisciplinary communication, and prompt specialist intervention when managing patients with extensive head and neck malignancy.