Difficult airway management in a child with Treacher Collins syndrome and cleft palate

ABSTRACT Anaesthesia for patients with Treacher Collins syndrome (TCS) can be challenging due to their craniofacial abnormalities and potential difficult airway. TCS presents with micrognathia and retrognathia, a small oral aperture, and severe temporomandibular joint abnormalities. Its association with cleft palate increases the difficulty in airway management. A 16-month-old male patient with TCS and bilateral cleft of palate presented for primary palatorrhaphy. Our airway management plan and the difficulties we encountered at 1 st attempt with fiber optic intubation and a subsequent successful 2 nd attempt are described. The insertion of an improvised nasopharyngeal airway ensured that postoperative airway obstruction did not occur. We review the literature of various techniques described for the airway management of children with TCS. Airway management of patients with TCS is challenging. A difficult airway management plan should be discussed by the team before the induction of anesthesia. Proficiency in the use of fiber optic bronchoscope for intubation of patients with TCS can reduce the perioperative risk associated with their airway management.