Giant vocal fold granulomas are pathologically benign growths, but their size and location in the larynx can turn a routine anesthetic into a high-stakes procedure. Because the lesion occupies airway space, it can cause obstruction severe enough to be fatal, and placing a breathing tube around it demands unusual care.
The report, authored by Duo Yang, Renzhe Lin, Sen Li, Zitian Luo, Dongxian Zhou, Qionghui Chen, Huankai Zhang and Longsheng Zhang, appears as an open-access case report with a permanent DOI. Both patients had favorable routine airway findings, with Mallampati classes I to II and normal neck mobility, and both were breathing spontaneously before surgery. When the team proposed awake tracheal intubation, the standard precaution for anticipated difficult airways, both women declined, showing psychological resistance and an inability to cooperate.
Faced with patients who refused awake intubation, the anesthesiologists chose an individualized alternative: slow induction of general anesthesia with spontaneous breathing deliberately preserved. Conventional rapid induction with neuromuscular blockade abolishes spontaneous breathing and, the authors note, may leave only a narrow rescue window if airway obstruction worsens once the patient is anesthetized. Awake intubation, meanwhile, is often limited by patient intolerance or contraindications, which was precisely the situation here.
Anesthesia was induced with sufentanil, propofol and remifentanil, titrated carefully to keep the patients in deep sedation while maintaining their own respiratory drive. Once adequate depth was reached, the team performed Disposcope endoscope-guided tracheal intubation under deep sedation, taking care to avoid contact with the granuloma.
After the tubes were successfully placed, mechanical ventilation took over and anesthesia was maintained with a combination of sevoflurane, propofol, dexmedetomidine and remifentanil. The surgical resections themselves were brief, lasting 15 minutes in one patient and 20 minutes in the other. Both patients underwent uneventful extubation at the end of surgery and recovered without reported complications, according to the case presentation.
The authors are explicit that these two successes should not be read as a general endorsement of the technique. In their conclusion, they state that the favorable outcomes may have been contributed to by the complete management strategy rather than by slow induction itself. They list the contributing factors: favorable routine airway findings, low mobility of the lesion, careful drug titration, preoxygenation, visual guidance from the endoscope, operator experience, and immediate otolaryngology backup available in the operating room.
The report also carries an unusually strong disclaimer for a case series of two. The authors state that it does not aim to establish slow induction as a safe, superior, or generally applicable alternative to awake tracheal intubation, and that these cases provide no evidence that slow induction is safe, safer than, or an established alternative to the awake approach.
What the report does offer is a documented example of how the components of a difficult-airway plan can be assembled when the first-choice option is off the table. Keeping spontaneous breathing during induction preserves a physiological safety net, since a sedated but breathing patient can still ventilate if the tube cannot be passed. For readers managing similar lesions, the value lies in the details of that layered plan, not in the induction technique alone, and the authors’ caution about generalizing from two carefully selected patients should frame any interpretation of the findings.
Subject of Research: Airway management with a Disposcope endoscope during slow induction in two patients with giant vocal fold granulomas
Article Title: Disposcope endoscope-guided tracheal intubation under slow induction with preserved spontaneous breathing in two patients with giant vocal fold granuloma: two case reports
Article References: Yang, D., Lin, R., Li, S., Luo, Z., Zhou, D., Chen, Q., Zhang, H., & Zhang, L. (2026). Disposcope endoscope-guided tracheal intubation under slow induction with preserved spontaneous breathing in two patients with giant vocal fold granuloma: two case reports. BMC Surgery. https://doi.org/10.1186/s12893-026-04299-9
Image Credits: AI Generated
DOI: 10.1186/s12893-026-04299-9
Keywords: Disposcope endoscope, tracheal intubation, vocal fold granuloma, slow induction, spontaneous breathing, difficult airway, case report, anesthesia, laryngeal lesion, awake intubation, BMC Surgery, Disposcope
News Source: Ophelia Keating. (October 29, 2026). Disposcope-Guided Intubation with Preserved Breathing in Giant Vocal Fold Granuloma Cases. Scienmag.
