Anesthetic airway management in an infant with congenital macrostomia associated with an oblique facial cleft

Abstract

This case report describes the anesthetic airway management of a 9-month-old infant with congenital macrostomia associated with an oblique facial cleft undergoing elective surgical correction. Inhalational induction was performed with sevoflurane, followed by orotracheal intubation. Initial mask ventilation presented obstruction due to posterior tongue displacement, which was successfully managed using an oropharyngeal airway. Direct laryngoscopy revealed a Cormack-Lehane IIa view, facilitated by the increased mouth opening caused by macrostomia. Extubation was performed with the patient awake to protect the airway from potential blood aspiration; however, vigorous post-extubation crying led to a hematoma and suture dehiscence, requiring surgical re-exploration under intravenous sedation. This case highlights how craniofacial malformations can differently affect various steps of airway management and emphasizes the dilemma of extubation strategy in pediatric facial reconstructive procedures.