ABSTRACT : intubating a child with restricted mouth opening especially when appropriate size fibrescope not available.

ABSTRACT: Intubating a patient with temporomandibular joint ankylosis is always difficult and it becomes more challenging when the patient is of paediatric age group. We describe the anaesthetic management of a case of paediatric difficult airway especially when the appropriate size fibre- optic bronchoscope is not available. Anaesthetic depth was maintained with sevoflurane by insufflating through an endotracheal tube introduced into oral cavity. We managed the case successfully by introducing fibre- optic bronchoscope through one nostril and endotracheal tube through other. During intra- op period patient was haemodynamically stable and prior to end of surgery, surgeon assured adequate mouth opening. On conclusion of surgery child could be extubated without any problem.