ABSTRACT : Maintaining a patent airway and ensuring adequate oxygenation is primary duty of anaesthesiologist. Once airway is secured in cases with difficult airway, anaesthesiologist assumes that the job is done. However, if there is an accidental loss of airway, particularly in surgeries involving upper airway, consultant is left with meager options, if any, to control airway.

METHODS : 8 year old girl with cleft palate, tongue adhesions and grossly restricted mouth opening with history of repeated surgeries for the same was posted for tempero manidbular joint release, palatoplasty and tongue release. Airway was secured with a nasotracheal tube under fiberoptic assistance under inhalational anaesthesia. When surgeon attempted to assess the extent of tongue adhesion to oral and oropharyngeal structures, accidental extubation was noticed. As other means to reestablish control over airway failed, surgical tracheostomy was performed and patient recovered without any complications.

RESULTS : Though, theoretically several options were available to regain airway control, many are not practical either due to unavailability of equipment or unsuitability owing to the circumstances for eg: Fiberoptic bronchoscope and blood in upper airway. Situation was salvaged with the best outcome for the patient as the airway control was regained expedisiously without attempting multiple other means.

CONCLUSIONS : Strict vigilance, and awareness of difficult airway algorithms and preparedness to face any eventuality are essential in managing such rare unforeseeable complications.