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Elective front-of-neck access (FONA) may serve as a bridging technique. Case representation: An 8-year-old with severe airway compromise from a large tonsillar mass underwent elective FONA planning. After failed intubation, needle cricothyroidotomy and subsequent tracheostomy enabled surgery, with later extubation.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/an-elective-front-of-neck-access-as-an-escape-room-in-a-case-of-tumour-obstructing-the-airway-in-a-child-a-case-report/406945/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/an-elective-front-of-neck-access-as-an-escape-room-in-a-case-of-tumour-obstructing-the-airway-in-a-child-a-case-report/406945.png","ImageObject",300,407,{"name":92,"@type":93},"WPS_1790064749","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is emergency front-of-neck access uncertain in young children during CICO?","Question",{"text":112,"@type":113},"Consensus is limited because evidence is scarce and many pediatric difficult airway guidelines emphasize preventing CICO. Anatomical factors in children also complicate identifying and performing cricothyroid membrane puncture and cannulation.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What clinical problem did the child have in the case report?",{"text":117,"@type":113},"An 8-year-old boy had a large oropharyngeal/tonsillar mass causing choking during sleep and drooling. Imaging showed a mass significantly compromising the airway.",{"name":119,"@type":110,"acceptedAnswer":120},"How was the airway managed after intubation attempts failed?",{"text":121,"@type":113},"After adequate pre-oxygenation and airway management with high-flow nasal oxygenation, oral video-laryngoscopy intubation failed. An immediate needle cricothyroidotomy was performed, followed by manual ventilation via a cannula; tracheostomy was then done to complete surgery, and later extubation occurred after 24 hours.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},406945,1790968021,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},3985747859154,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Baykuziyev etal. BMC Anesthesiology (2025) 25:621  \n[https://doi.org/10.1186/s12871-025-03461-9](https://doi.org/10.1186/s12871-025-03461-9)  \nBMC Anesthesiology  \nCASE REPORT Open Access  \nAn elective Front-of-neck-access as an escape room in a case of tumour obstructing the airway in a child: a case report  \nTemur Baykuziyev 1,4*, Preethi Thomas 1, Aneesha Thankamony 1, Mashael Al Khelaifi 1,2, Abdulla Majid3, Rahman Waheed3 and Nabil A. Shallik2,4  \nAbstract  \nBackground Little agreement exists on how to perform emergency front of the neck access (eFONA) in children less than 8 years old in cannot intubate-cannot oxygenate (CICO) situations. This uncertainty arises due to the scarcity of evidence and the predominant emphasis on CICO prevention in most paediatric difficult airway management guidelines and algorithms. An elective FONA can be implemented as a bridging technique for an anticipated CICO scenario.We present here a case of performing an elective FONA as a bridging technique in a paediatric patient with the airway obstruction caused by a gigantic tonsil lar mass.  \nCase representation An 8-year-old previously healthy child presented with a throat mass, associated with choking during sleep and drooling of saliva. The mass appears in the throat and covers the uvula when the child opens his mouth. A Computer tomography of the neck with contrast demonstrated a large oropharyngeal mass lesion measuring 37 × 33 × 54 mm, significantly compromising the airway. He was admitted for an elective oropharyngeal mass excision. The landmarks for cricothyroidotomy and tracheostomy were marked on the child’s skin before administering anaesthesia.  \nAfter adequate pre-oxygenation, the intravenous and inhalational anaesthetics were administered judiciously to keep the ventilation spontaneous. A High Flow Nasal Oxygenation was provided throughout the airway management. An attempt at oral endotracheal intubation using video-laryngoscopy failed, after which an immediate needle cricothyroidotomy was performed by surgeons to avoid impending airway loss. A flow controlled manual ventilation was performed via a 16-G cannula to oxygenate patient. The second trial of intubation was not successful. It was decided to perform a tracheostomy for the completion of the surgery. Subsequently, the patient was intubated orally after an oropharyngeal mass excision and right tonsillectomy. The tracheal stoma was closed considering a high risk of tracheal stenosis. The patient was transferred to the paediatric intensive care, where he was extubated after 24 h.  \n*Correspondence: Temur Baykuziyev [baykuziyev@yahoo.com](baykuziyev@yahoo.com)  \nFull list of author information is available at the end of the article  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/.  \nBaykuziyev et al. BMC Anesthesiology (2025) 25:621 Page 2 of 8  \nConclusion En elective FONA should be considered as a bridging technique in the management of an anticipated upper air","cbCaibyc1Jax65pG","https://ap.wps.com/l/cbCaibyc1Jax65pG","pdf",1597783,"English","# Abstract\n## Background\n## Case representation\n## Conclusion\n# Keywords\n# Background\n## Pediatric FONA challenges\n## Elective FONA as bridging\n# Case presentation","[{\"question\":\"Why is emergency front-of-neck access uncertain in young children during CICO?\",\"answer\":\"Consensus is limited because evidence is scarce and many pediatric difficult airway guidelines emphasize preventing CICO. Anatomical factors in children also complicate identifying and performing cricothyroid membrane puncture and cannulation.\"},{\"question\":\"What clinical problem did the child have in the case report?\",\"answer\":\"An 8-year-old boy had a large oropharyngeal/tonsillar mass causing choking during sleep and drooling. Imaging showed a mass significantly compromising the airway.\"},{\"question\":\"How was the airway managed after intubation attempts failed?\",\"answer\":\"After adequate pre-oxygenation and airway management with high-flow nasal oxygenation, oral video-laryngoscopy intubation failed. An immediate needle cricothyroidotomy was performed, followed by manual ventilation via a cannula; tracheostomy was then done to complete surgery, and later extubation occurred after 24 hours.\"}]","An elective Front-of-neck-access as an escape room in a case of tumour obstructing the airway in a child - a case report | PDF",1790569107]