PMC3558652_01
Photographs of the Patient on Admission. There are severe contractures of the mandible, the neck and the lower part of the face, with narrow nares and a small oral opening (microstomia) that were due to the facial and perioral contractures. The neck is held in flexion, and the mandible is regressed and fixed near the sternum, impossible for the patient to extend the neck or distract the mandible. The structure of anterior neck is unidentifiable and impalpable.
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F1
The cervicomental and the mentosternal angles were completely obliterated by thick stiff scars, and the anterior neck structures, including the larynx, the trachea, and the carotid arteries, were not identifiable or palpable (Fig. 1).
Intubated state after release of the neck and mouth contractures. The solid line is drawn a transverse incision line under local anesthesia. And the part between a solid line and a dotted line is released area.; this requires dissecting nearly whole circumference of the neck, leaving a large, stellate wound involving the lower face, the neck, the upper chest.
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F2
In spite of dissecting nearly the whole circumference of the neck, the mouth opening was only enough to allow passage of the blade of laryngoscope (Fig. 2).
(A) Awake intubation using fiberoptic bronchoscopy under GlideScope  Video laryngoscope guide. (B) The GlideScope  monitor display image of endotracheal tube passing through the vocal cord.
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F3
After applying topical lidocaine spray to the oral cavity and pharynx, orotracheal intubation with a cuffed endotracheal tube (7.0 mm ID) was performed with the use of fiberoptic bronchoscopy under GlideScope  Video laryngoscope guidance (Fig. 3).