Combined Fiberoptic and video Laryngoscopic intubation for difficult airway management in a child with turner syndrome and isolated secondary cleft palate

Abstract

Turner syndrome and craniofacial abnormalities, such as cleft palate, can contribute to significant challenges in airway management due to associated dysmorphic features. Here is the case of a 14 year old girl suspected to have TS with palatal discontinuity scheduled for primary palate repair under general anaesthesia. During the pre-anaesthetic evaluation, she exhibited short stature, a webbed neck, facial dysmorphic features, and restricted mouth opening, indicating a potentially difficult airway. Awake fiberoptic intubation was planned with alternative strategies and airway optimization using local anaesthetics. However, multiple attempts were unsuccessful by a large, edematous epiglottis obscuring the glottic opening. A combined approach utilizing awake fiberoptic bronchoscopy and C-Mac video laryngoscopy successfully facilitated intubation without complications. This case underscores the importance of thorough preoperative assessment, meticulous planning for handling a difficult airway, and the necessity of backup plans to address potential challenges effectively.