Airway Management in Paediatric Mandibulofacial Dysostosis: The Role of Air-Q as a Life-Saving Conduit During Cleft Repair Surgery

Mandibulofacial dysostosis, commonly known as Treacher-Collins syndrome, is a rare congenital craniofacial disorder that presents significant challenges in airway management due to facial anatomical deformities. These difficulties are further compounded in paediatric patients, particularly during surgeries such as cleft lip and palate repair. This case report describes the perioperative airway management of a 4-year-old male with Treacher-Collins syndrome undergoing cleft surgery. The child’s preoperative assessment revealed typical features of the syndrome, including micrognathia, retrognathia, and hypoplasia of facial bones, indicating a high risk for difficult intubation. Intraoperatively, accidental displacement of the endotracheal tube led to rapid desaturation. An Air-Q™ intubating laryngeal mask airway (LMA) was immediately inserted, thereby ensuring adequate ventilation and a rapid improvement in oxygen saturation. Once the patient was stabilised, fibre-optic-assisted intubation was successfully performed through the Air-Q, and surgery continued without further complications. Its use as a conduit for fibre-optic intubation not only provides hands-free ventilation but also helps reduce the risk of airway trauma and obstruction. This case illustrates the use of the Air-Q as a rescue airway conduit in a paediatric patient with Treacher-Collins Syndrome, highlighting its potential to improve perioperative safety and preparedness.