• Yuchao Liu, Zijia Liu, Yang Zha, and Xuerong Yu.
• Department of Anesthesiology.
• Medicine (Baltimore). 2021 Apr 9; 100 (14): e25455e25455.

RationaleAn impacted foreign body (FB) in the larynx of an adult is a rare but potentially life-threatening occurrence. Patients with Down's syndrome (DS) are vulnerable to airway FB. However, the anesthesia for FB removal can be challenging. This report describes a case in which a FB was impacted between the vestibular folds in an adult with DS, congenital heart disease, and a difficult airway.Patient ConcernsA 41-year-old woman swallowed a piece of sharp-tipped wooden skewer presented with a sudden onset of aphonia, dysphagia, and an acute sore throat without respiratory difficulty. The patient had DS, congenital heart disease, pulmonary arterial hypertension, and severe obstructive sleep apnea-hypopnea syndrome. The airway evaluation indicated that ventilation and intubation would be difficult due to retrognathia, macroglossia, adenotonsillar hypertrophy, and Mallampati's classification III.DiagnosisThe clinical symptoms and laboratory examination confirmed FB penetrated between the vestibular folds.InterventionsAfter careful multidisciplinary preoperative assessment and preparation, the FB was removed successfully by direct laryngoscopy under moderate sedation and spontaneous ventilation, with the application of 1% lidocaine as topical anesthesia.OutcomesThe laryngeal FB was removed successfully without any complications. And the patient was discharged home the next day.LessonsThis case report shows the importance of anesthetic depth for laryngeal FB removal. The use of moderate sedation (allowing spontaneous ventilation) and adequate analgesia combined with local anesthesia enabled the patient to withstand the stress of direct laryngoscopy. Appropriate assessment, careful preparation, and multidisciplinary collaboration yielded the smooth removal of a laryngeal FB in an adult with DS.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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