Authors: Lorette CL et al.
Cureus, June 9, 2026.
Summary
This case report describes the successful use of a distal pharyngeal airway as a rescue device in two severe airway emergencies when conventional techniques were ineffective.
The distal pharyngeal airway is designed to extend beyond the tongue base toward the epiglottis. This allows it to address obstruction occurring deeper in the pharynx than a conventional oropharyngeal or nasopharyngeal airway can reach. It can also be used with positive-pressure ventilation.
Case 1 involved a 47-year-old man with a body mass index of 46, obstructive sleep apnea, diabetes, hypertension, gastroesophageal reflux disease, and cardiac dysrhythmias. He underwent sedation for elective upper gastrointestinal endoscopy.
After receiving propofol and insertion of the endoscope, his oxygen saturation rapidly decreased from 99% to 60%. A jaw-thrust maneuver was unsuccessful.
The endoscope was removed, and a size 4 distal pharyngeal airway was inserted through an opening in the endoscopic bite block. Bag-mask ventilation was then provided through the device. End-tidal carbon dioxide was detected immediately, and oxygen saturation recovered within approximately 30 seconds.
The endoscopy was subsequently completed, and the patient recovered without complications.
Case 2 involved a 69-year-old woman who developed acute neck swelling, hoarseness, and respiratory distress shortly after thyroid lobectomy. Imaging demonstrated a postoperative hematoma with tracheal displacement.
The expanding hematoma eliminated recognizable anterior neck landmarks and created a potentially catastrophic airway emergency.
Following rapid-sequence induction, attempts with two different video laryngoscopes failed to visualize the epiglottis or vocal cords. Placement of a supraglottic airway also failed to provide ventilation, and the patient’s oxygen saturation fell to 60%.
A size 4 distal pharyngeal airway was then inserted. Two-person mask ventilation successfully restored oxygenation and provided approximately three minutes of effective ventilation while awaiting surgical decompression.
After the hematoma was evacuated, the patient was successfully intubated using video laryngoscopy and a bougie. She was extubated without incident on postoperative day 2 and discharged home on postoperative day 3.
What You Should Know
The distal pharyngeal airway extends farther than conventional oral or nasal airways and is intended to relieve obstruction near the epiglottis.
It may provide positive-pressure ventilation when jaw thrust, standard airway adjuncts, video laryngoscopy, or a supraglottic airway have failed.
In the endoscopy case, the device could be inserted through the bite block without completely disrupting the procedural setup.
In the post-thyroidectomy hematoma case, it served as a temporary bridge that restored ventilation while definitive surgical and airway management were organized.
The device does not replace endotracheal intubation or surgical airway access when those interventions are necessary.
Its greatest potential role may be as an immediately available rescue device between basic airway maneuvers and more advanced airway procedures.
Post-thyroidectomy neck hematoma remains a surgical airway emergency. Prompt wound opening and hematoma evacuation should not be delayed when airway compromise is developing.
The report includes only two cases and does not establish that the device is superior to established airway adjuncts.
The article also appears closely connected to the manufacturer’s proprietary device materials, so larger independent studies are needed to confirm effectiveness, safety, and appropriate indications.
Successful use requires familiarity with device sizing, insertion, mask seal, and the manual occlusion technique needed to deliver positive-pressure ventilation.
The cases reinforce the importance of early recognition, a structured failed-airway plan, team coordination, and immediate access to multiple rescue options.
Thank you to Cureus for allowing us to summarize this article.