Intraoperative leak due to an armored endotracheal tube damage during head and neck surgery: A rare but dreaded complication – A case report

Head and neck cancer surgeries are precariously known for intraoperative damage to the endotracheal tube due to the presence of a shared airway and the routine use of sharp surgical instruments in close proximity to the airway. Such damage can result in significant airway compromise, leading to hypoxia, loss of ventilation, and an increased risk of aspiration. Prompt recognition and timely management of a damaged endotracheal tube are therefore crucial during the intraoperative period, particularly in patients with an anticipated difficult airway. Airway management in this scenario is further complicated by limited access, ongoing surgery, and the need to maintain oxygenation without interrupting the surgical field. Intraoperative endotracheal tube damage in a difficult airway with a shared surgical field requires careful planning, clear communication with the surgical team, and preparedness for definitive airway management. We report a case of accidental intraoperative endotracheal tube damage in a 53-year-old male undergoing head and neck cancer surgery with a known difficult airway. The airway was successfully secured by exchanging the damaged endotracheal tube using a video laryngoscope and a gum elastic bougie without compromising oxygenation or hemodynamic stability. This case highlights the importance of vigilance, early recognition, and the availability of advanced airway adjuncts in managing unexpected airway emergencies during head and neck oncological surgeries.