Successful Awake Blind Nasal Intubation for Airway Management of a Giant Parapharyngeal Space Tumor in a Resource-Limited Setting

Introduction

Parapharyngeal space (PPS) tumors are rare and account for approximately 0.5% of all head and neck tumors. Their close proximity to the upper airway can result in significant anatomical distortions, making airway management challenging. Awake tracheal intubation is recommended when a difficult airway is anticipated; however, advanced airway devices such as flexible fiberoptic bronchoscopes and videolaryngoscopes may not be available in low-resource settings. Awake blind nasal intubation (ABNI), although rarely practiced today, may be a feasible alternative in carefully selected patients.