Background: Induction of general anesthesia in a patient with
compromised airway has always caused dilemma to anesthesiologist,
especially for toddler this is paramounted. Case Presentation: An 18
month old boy had a huge sized lingual mass which not only filled
entire oral cavity but protruded outside the mouth up to about 5 cm.
Having in mind the diagnosis of hemangioma, prior to induction it was
attempted to reduce the mass but could be reduced only minimally by
manual decompression. While the tongue, still outside the mouth, with
full preparedness for anesthesia was induced maintaining the
spontaneous ventilation. During laryngoscopy and intubation the tongue
was pulled out of the oral cavity to ease the passage of the
endotracheal tube. The mass was excised successfully and patient had an
uneventful postoperative course. Conclusion: Maintenance of spontaneous
ventilation is the crucial safety element during induction