Introduction : Treacher Collins syndrome also known as Mandibulo facial dysostosis is a rare craniofacial anomaly characterised by bilateral and symmetric underdevelopment of structures deriving from the first and second pharyngeal arch, groove and pouch leading to hypoplasia of the supraorbital rims, zygoma, midfacial bones, mandible as well as ear and palatine deformities.

Materials and Methodology : Our patient is a 18 year old unmarried female who is a known case of Treacher Collins syndrome now presenting with solitary nodular goiter in Right lobe of Thyroid planned for Hemithyroidectomy. An awake retrograde nasotracheal intubation was done after anaesthetising the airway over a period of five minutes. General anaesthesia was instituted with N2O:O2 3:1.5 and Sevoflurane 0.5-1% . 2 hours intraoperative period went uneventful. On table extubation was deferred owing to difficult airway and post hemithyroidectomy status. Patient was mechanically ventilated and extubated the next day.

Discussion : These patients are not only difficult to intubate but may be nearly impossible impossible to mask ventilate. Hence induction follows endotracheal intubation. Maneuvers to pull the tongue forward are helpful. Direct laryngoscopy is generally difficult regardless of blade type. Timing of extubation is important on account of post airway instrumentation edema with difficult rescue mask ventilation and intubation.

Conclusion : It is a rare autosomal dominant genetic disorder with concerns relating mainly to airway management and identification and optimisation of associated anomalies during surgical procedures while securing airway with spontaneous ventilation.