To the Editor, The following describes novel airway management in a 60-yr-old female patient with inspiratory stridor, orthopnea, and dyspnea from critical tracheal stenosis. On examination, a 6 9 9 cm neck swelling extended between the cricoid cartilage and the suprasternal notch. The patient’s neck movements were normal, her mouth opening was 4 cm, and the Mallampati score was 3. Nasopharyngoscopy showed a normal glottic opening and mobile vocal cords.

Computed tomography showed a large thyroid mass invading the trachea, extending beyond the suprasternal notch, and causing the trachea to deviate to the left. The intratracheal portion of the mass beginning below the cricoid cartilage extended to the first four annular cartilages, obstructing approximately 80% of the lumen so that the widest diameter in this region was 5 mm. Ultrasonography revealed a 4 9 6 cm right thyroid lobe infiltrating the trachea. The thyroid extended beyond the suprasternal notch, which precluded tracheostomy or suprasternal needle tracheotomy.