ABSTRACT : airway surgeries always are challenging.

METHODS : We present a case of 7 years old boy operated already four times for cleft lip and palate. For his fifth surgery, child had deliberately leftout anterior palatal fistula which was planned to be covered with posterior tongue flap. This surgical session went uneventful. On second stage surgery for dissection of tongue flap, child again approached us. It was a challenge to anaesthetize such children as we don’t have paediatric fiberscope. However, without fiberoptic intubation we were successfully able to allow surgery to proceed unhindered.

RESULTS : We will be discussing the anaesthetic management in such cases of difficult airway management under ideal conditions and also in places which function on limited resources.