“Never burn your bridges” – A difficult airway scenario

Anaesthesia for otorhinolaryngological procedures has always been challenging in view of a shared and often difficult airway. A 55-year-old male, a known case of carcinoma right maxilla, presented to us following right total maxillectomy, bilateral anterior and posterior ethmoidectomy, sphenoidectomy and right supraomohyoid neck dissection. He needed a revision maxillectomy in view of a residual lesion predominantly in the right superior nasal cavity and maxillary sinus. Mouth opening was restricted to 1.5 cm making direct laryngoscopy impossible. The mass in the right nasal cavity had eroded and caused deviation of the nasal septum completely towards the left, making nasal fibrescopy also difficult. We successfully managed the airway using the technique of asleep oral fibreoptic-guided intubation.