{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T05:25:27Z","timestamp":1764739527251,"version":"3.46.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>We report the case of an 80-year-old male with a giant palatal pleomorphic adenoma (7.0 \u00d7 5.0 \u00d7 5.5 cm) that caused progressive dyspnea, dysphagia, and oropharyngeal airway distortion after 40 years of indolent growth. To our knowledge, this represents one of the largest documented cases in which awake transnasal tracheal intubation was performed for an intraoral tumor. Preoperative evaluation revealed nasopharyngeal-nasal junction narrowing, a mouth opening of 3 cm, Mallampati grade IV, and preserved glottic function. Multimodal imaging\u2014including MRI, 3D CT reconstruction, and fiberoptic laryngoscopy\u2014was critical in delineating tumor extent and airway anatomy, guiding a tailored airway management strategy. Awake transnasal fiberoptic tracheal intubation was performed via the right nostril using dexmedetomidine sedation, topical and regional anesthesia, and ultrasound-guided superior laryngeal nerve blocks. Intubation was successful on the first attempt, without the need for tracheotomy or procedural complications. The procedure lasted 90 minutes, with minimal blood loss and stable hemodynamics. The patient was extubated on postoperative day 1, discharged on day 10, and remained clinically stable at 6-month follow-up.<\/jats:p>","DOI":"10.3389\/fonc.2025.1723032","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T05:20:25Z","timestamp":1764739225000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal imaging\u2013guided awake transnasal fiberoptic tracheal intubation in a patient with giant palatal pleomorphic adenoma: a case report"],"prefix":"10.3389","volume":"15","author":[{"given":"Feng-Jiao","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"B1","volume-title":"Oral Histopathology","author":"Yu","year":"2012"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2016.09.021","article-title":"Salivary gland tumours in a northern Chinese population: a 50-year retrospective study of 7190 cases","volume":"46","author":"Gao","year":"2017","journal-title":"Int J Oral Maxillofac Surg"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.1002-0098.2019.01.003","article-title":"Clinical pathologic analysis on 3724 cases of salivary gland tumors","volume":"54","author":"Lyu","year":"2019","journal-title":"Chin J Stomatol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e068779","DOI":"10.1136\/bmjopen-2022-068779","article-title":"Comparison of modified anterior and traditional posterior accesses for ultrasound-guided superior laryngeal nerve block in awake endotracheal intubation: study protocol for a randomised non-inferiority clinical trial","volume":"13","author":"Hua","year":"2023","journal-title":"BMJ Open"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e7786","DOI":"10.1002\/ccr3.7786","article-title":"Management of a giant pleomorphic adenoma of the soft palate: A case report","volume":"11","author":"Nnko","year":"2023","journal-title":"Clin Case Rep"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.13201\/j.issn.1001-1781.2014.24.028","article-title":"A case report of surgical resection of giant pharyngeal pleomorphic adenoma and literature review","volume":"28","author":"Luo","year":"2014","journal-title":"Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/omcr\/omac083","article-title":"Oropharyngeal pleomorphic adenoma causing complete airway obstruction and cardiopulmonary arrest","volume":"2022","author":"Ono","year":"2022","journal-title":"Oxf Med Case Rep"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.5001\/omj.2017.44","article-title":"Giant parapharyngeal space pleomorphic adenoma causing acute airway obstruction","volume":"32","author":"Bist","year":"2017","journal-title":"Oman Med J"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.rodmex.2016.11.016","article-title":"Giant pleomorphic adenoma of the palate. 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