Securing an airway in pediatric patients with TMJ ankylosis with nil mouth opening is an anesthetic challenge. Among the methods available including submandibular intubation, retrograde intubation and tracheostomy, fiberoptic nasotracheal intubation technique remains gold standard. Self-awareness and calmness are important attributes of an anaesthetist during such cases. Prior planning of the anesthetic technique and good rapport with surgeon are of key importance for successful outcomes of such difficult airway cases. We present a case of Right Temporomandibular Joint Ankylosis for surgery in a pediatric age-group with nil mouth opening managed successfully with fiberoptic bronchoscope.
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