Airway Management of a 6-Month Baby with Bilateral Tessier Type 4 Deformity Operated for Combined Cleft Lip and Palate Repair - A Case Report

Tessier Type 4 deformity is an uncommon craniofacial anomaly where the bilateral orbits communicate with ipsilateral oral cavity forming cleft lip and palate and is associated with hypoplastic maxillae. This interferes with the anesthesiologist’s effort to provide an adequate seal for mask ventilation, perform a good laryngoscopy as the upper jaw is divided into three parts and sets up for a challenging intubation due to suboptimal laryngoscopy. Combined with the common paediatric anaesthetic concerns like reduced apnoeic time, inability to perform awake intubation and more technically difficult front of neck access, the planning for airway management needs to be elaborate and well defined. This poster demonstrates the successful airway management for this six-month-old baby consisted of a well-defined intubation plan focusing on adequate pre-oxygenation with an adult size face mask. Avoiding muscle relaxation, apnoeic oxygenation with the use of Oxyport Miller blade, using Frova intubating introducer for guidance and ventilation Avoiding injury to the cornea as there is ectropion of the lower eyelid, having backup video laryngoscope, fibreoptic scope and ENT surgeon.