Airway Management of a Paediatric Patient Posted for Repair of Bilateral Tessier Facial Cleft

Abstract Tessier cleft is a very rare craniofacial anomaly. The main challenge for anaesthesiologists is airway management. We present a case of a 2-year-old who presented for the repair of bilateral Tessier clefts. Although the Mallampatti grade was I, the presence of a wide mouth poses a challenge in achieving a tight seal during mask ventilation. Use of soft pads with a larger-size mask is helpful but cannot guarantee effective ventilation. This puts pressure on the eyes and strains anaesthesiologists’ hands. Insertion of a supraglottic airway eliminated these problems while providing adequate ventilation. Facial bony anomalies further complicated anaesthesia in endotracheal tube selection and performing nerve blocks. Because of the wide mouth, the anaesthesia planning needed strategies for mask ventilation plus preparedness for an unanticipated difficult airway, which facilitated uneventful anaesthesia management.