{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:47:20Z","timestamp":1792043240168,"version":"4.4.0"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":286,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Anesthesiology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Awake fiberoptic intubation (AFOI) remains the preferred technique for anticipated difficult airway management. However, severe restriction of mouth opening, fixed craniocervical anatomy, and sedation\u2010induced hypopharyngeal collapse may substantially impair endoscopic visualization and increase procedural difficulty. Simple mechanical maneuvers that improve upper airway patency may facilitate successful intubation in these highly challenging patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      We report the airway management of a 24\u2010year\u2010old woman with Ehlers\u2013Danlos\u2010hypermobile type (EDS\u2010HT) syndrome, previous craniocervical fusion, severe temporomandibular dysfunction, and a history of a prior\n                      <jats:italic>cannot intubate, cannot oxygenate<\/jats:italic>\n                      event requiring emergency tracheostomy. Preoperative evaluation demonstrated extreme anatomical airway restriction, including complete absence of cervical extension, severely limited mouth opening, and ultrasonographic evidence of markedly reduced submandibular compliance (hyomental distance 2.8\u2009cm; hyomental distance ratio 1.0). During the first\u2010stage spinal surgery, awake fiberoptic orotracheal intubation in the supine position, with dexmedetomidine\u2010light sedation and local anesthesia, was initially hindered by severe hypopharyngeal collapse. Application of lingual traction immediately restored glottic exposure, allowing successful first\u2010attempt intubation. Seven days later, during the second\u2010stage procedure, AFOI was performed in the left lateral decubitus position combined with lingual traction. This approach further improved airway patency, reducing the time to glottic visualization from 15 to 5\u2009s and total intubation time from 90 to 30\u2009s, while maintaining first\u2010pass success.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case illustrates that combining lingual traction with lateral decubitus positioning can mechanically optimize upper airway patency during AFOI in patients with fixed craniocervical anatomy and EDS\u2010HT patients. These simple, low\u2010cost, and readily reproducible maneuvers may represent valuable adjuncts when conventional airway techniques are limited or contraindicated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/cria\/7693647","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:10:13Z","timestamp":1792041013000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lingual Traction and the Lateral Decubitus Position Facilitate Awake Fiberoptic Oral Intubation in a Patient With Ehlers\u2013Danlos Syndrome (Hypermobile Type) and Craniocervical Fixation: A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1396-8382","authenticated-orcid":false,"given":"Carlos","family":"Ram\u00edrez-Paesano","sequence":"first","affiliation":[{"name":"Servei Central Anestesia (Anestalia) Centro M\u00e9dico Teknon Grupo Quir\u00f3nsalud.  c\/Vilana, 12. Barcelona 08017 Spain  teknon.es"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Valente-Rivero","sequence":"additional","affiliation":[{"name":"Hospital Clinic Universitat de Barcelona  c\/Villarroel, 170 Barcelona 08036 Spain  ub.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0223-4732","authenticated-orcid":false,"given":"Eloymar","family":"Rivero-Novoa","sequence":"additional","affiliation":[{"name":"Servei Central Anestesia (Anestalia) Centro M\u00e9dico Teknon Grupo Quir\u00f3nsalud.  c\/Vilana, 12. Barcelona 08017 Spain  teknon.es"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0581-288X","authenticated-orcid":false,"given":"Yerlin Andr\u00e9s","family":"Colina-Vargas","sequence":"additional","affiliation":[{"name":"Servei Central Anestesia (Anestalia) Centro M\u00e9dico Teknon Grupo Quir\u00f3nsalud.  c\/Vilana, 12. Barcelona 08017 Spain  teknon.es"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Juanola-Galcer\u00e1n","sequence":"additional","affiliation":[{"name":"Servei Central Anestesia (Anestalia) Centro M\u00e9dico Teknon Grupo Quir\u00f3nsalud.  c\/Vilana, 12. Barcelona 08017 Spain  teknon.es"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0087-435X","authenticated-orcid":false,"given":"Gloria","family":"Molins","sequence":"additional","affiliation":[{"name":"Servei Central Anestesia (Anestalia) Centro M\u00e9dico Teknon Grupo Quir\u00f3nsalud.  c\/Vilana, 12. Barcelona 08017 Spain  teknon.es"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_2_12_1_2","first-page":"47","article-title":"Anesthesia Patient Safety Foundation Update: 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway","volume":"37","author":"Fiadjoe J. E.","year":"2022","journal-title":"APSF Newsletter"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14904"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-014-1920-9"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-42503-5"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-022-10469-7"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/5496368"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/87.2.207"},{"key":"e_1_2_12_8_2","article-title":"Lingual Traction and Lateral Decubitus Position to Facilitate Awake Fiberoptic-Guided Oral Endotracheal Intubation in an Ehlers\u2013Danlos Hypermobility-Type Patient With Occipito-Cervical Fixation and Severe Anatomical Airway Limitations","volume":"41","author":"Ramirez-Paesano C. 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