Difficult airway management in a case of bilateral congenital torticollis

Anatomical disorders of the head and neck pose a serious challenge to an anesthesiologist in terms of difficult intubation. Securing airway requires a detailed preanesthesia evaluation to assess any issues associated with the disease, especially concerning the airway. This is the case of a 46-year-old male with congenital bilateral torticollis posted for elective functional endoscopic sinus surgery. A detailed preanesthetic checkup was done and was anticipated a difficult airway situation, hence planned for an awake intubation. We performed a successful awake fiber-optic intubation. Excessive muscular atrophy and fibrosis characterize congenital bilateral torticollis, resulting in sternocleidomastoid tension and limited cervical motion. During intubation, asymmetry in the face caused a mismatch between the facial and cervical midlines, making sniffing difficult. Successful anesthetic management in a case of congenital bilateral torticollis requires thorough knowledge about the anatomical changes and also the expertise in fiber-optic bronchoscopy.