Oro-facial burns present with serious sequelae due to fibrosis and scarring leading to distortion of normal anatomy. Extensive fibrosis restricts mouth opening making oral intubation difficult which leads to complications like hypoxia, hypercarbia and anaesthesia related morbidity and mortality. Further, the distorted nasal anatomy leaves very few options for maintaining a patent airway.

We present a case of post oro-facial electrical burns with microstomia, and loss of alae nasi exposing nasal cartilage, posted for release of microstomia under general anaesthesia. Adequate local anaesthesia, nerve blocks and awake fiberoptic nasal intubation for securing the airway and balanced use of intravenous, inhalational anaesthetics and muscle relaxants aided in successful anaesthetic management of the patient

Anticipation of difficult intubation and preparation by keeping all possible options is the key for difficult airway management. Awake fiberoptic intubation is becoming a gold standard in management of difficult intubation situations as it provides excellent visualization of the glottis till the intubation is accomplished.

In conclusion, proper preoperative assessment, intraoperative preparedness and vigilance and team work are necessary for positive outcome in managing such cases.