ABSTRACT : : Airway management is a challenge to anesthesiologist owing to fixed flexion deformity resulting in nonalignment of oral, pharyngeal and laryngeal planes for intubation. We present the successful anesthetic management of a patient with obliteration of nasal passages, restricted mouth opening and severely limited neck extension and a fixed flexion deformity, mouth opening equal to two finger .Mallampati IV, thyromental distance could not be assessed. Trachea deviated to right posted for neck contracture release and skin grafting .

METHODS : : After obtaining informed written consent for general anesthesia and tracheostomy. Patient premedicated with glycopyrrolate, fentanyl and hydrocortisone. Preoxygenated with help of nasopharyngeal airway.Induced with ketamine propofol and sevoflurane. After failed laryngoscopy attempt LMA inserted. Following neck contracture release 7mm CETT placed after laryngoscopy. Perioperative and extubation was uneventful.

RESULTS : Successful management of difficult airway

CONCLUSIONS : Vigilance and meticulous preoperative preparedness for difficult airway is the key to success