ABSTRACT : We recently treated a 8 year old boy who presented with two sublingual cyst one being 2X1cm and other 1x1cm of 6 months duration,gradually increasing in size leading to slurred speech and pain. Sublingual dermoid cyst was diagnosed and intraoral excision was planned under general anaesthesia. The airway assessment revealed normal mouth opening with a Mallampati class 1

METHODS : Accordingly,it was deemed appropriate to proceed under GA with nasal intubation using 6.5mm ID PVC ET tube, iv induction was done with thiopentone sodium , muscle relaxation achieved with succinylcholine.

RESULTS : Sublingual dermoid cysts are uncommon and account for less than 1% of cystic intraoral lesion. Huge cyst may fill the entire oral cavity and render intubation extremely difficult or impossible. Suggested airway management strategies include blind-nasotracheal intubation , fibreoptic endoscope guided intubation and preliminary tracheostomy. Ideally, awake nasal intubation would be safest method for securing airway in such cases. Inducing with a inhalational agent with spontaneous breathing is another method for blind nasal intubation in a non cooperative child. Fiber optic endoscope intubation are technically demanding which are not universally available. Preliminary tracheostomy significantly increases morbidity. Collapsing the cyst with needle aspiration can improve the airway and facilitate intubation.

CONCLUSIONS : Though in our case it was a small sublingual cyst with adequate mouth opening, However patients with large cysts often prove to be difficult candidates for airway management. Pre-op airway assessment and appropriate planning can help anaesthesiologist in securing airway and managing such cases.