Further Evaluation

If there is suspicion of undetected disease, such as an airway tumor, or if the impact of such a tumor or an infection on airway management is not clear, consultation should be obtained for indirect or fiberoptic laryngoscopy. These may be the only methods to detect occult but life-threatening problems such as lingual tonsillar hyperplasia. Serious doubt about an airway may justify the presence of an otolaryngologist during induction to establish an airway surgically, if necessary.

The chest radiograph may reveal problems undetected by the history and physical examination. Lateral and anteroposterior cervical spine films should be obtained if the bony spine or joints may be a source of difficulty or if there is suspected encroachment on the airway. Computed tomography (CT) has been employed to evaluate the involvement of the trachea, bronchi, and cardiovascular structures in mediastinal tumors.^[12] Other means of airway assessment with magnetic resonance imaging have been used. However, simple measures such as flow-volume loops provide detection and assessment of the physiologic importance of extrathoracic or intrathoracic obstructive lesions.