Oral submucous fibrosis is a chronic complex irreversible precancerous condition with progressive fibrosis of submucosal tissues, leading to severly restricted mouth opening, intubating these patients poses a serious anesthetic challenge.

42y/M was planned for tympanoplasty with restricted mouth opening andsubmucous fibrosis with a positive history of betel nut chewing for 20 years. On examination his mouth opening was 1.5cm, sternomental , thyromental, mentohyoid distances were normal. Patient underwent appendicectomy under general anaesthesia 5 years back with a history of awakefiberoptic intubation for airway management. We planned for a videolaryngoscopy assisted intubation after ensuring adequate mask ventilation. Patient was premedicated with glycopyrrolate 0.2mg anaesthesia was induced with fentanyl, propofol, patient was then paralysed with succinylcholine. Laryngoscopy was done with C-MAC videolaryngscope using the D blade and trachea was intubated with a 8mm ID endotracheal tube with the help of stylet in the first attempt and placement was confirmed with capnography . After surgery neuromuscular blockade was reversed adequately and extubated. Intraoperative and postoperative periods were uneventful.

Fiberoptic intubation is the gold standard in these cases but videolaryngscopy has changed the elective management of difficult airway.

Submucous fibrosis, Difficult airway, videolaryngoscopy.