Urgent Complex Intraoperative Reintubation in a Known Difficult Airway After Endotracheal Tube Damage: A Case Report

Area of Science:

• Anesthesiology
• Genetics
• Pediatric Surgery

Background:

• Treacher Collins syndrome is a genetic disorder causing significant craniofacial abnormalities.
• Patients often require early and complex airway management due to malformed branchial arches.
• This case involves a 17-year-old with Treacher Collins syndrome and a history of difficult intubation.

Observation:

• The patient underwent an uneventful awake nasal fiberoptic intubation for the procedure.
• During the surgery, the nasotracheal tube was inadvertently damaged.
• The patient's complex craniofacial anatomy posed a significant challenge for airway management during the intraoperative complication.

Findings:

• A combination of a flexible fiberoptic bronchoscope and a ventilating exchange catheter was employed to manage the airway.
• These advanced airway tools facilitated the successful exchange of the damaged nasotracheal tube.
• The perioperative management successfully navigated an urgent situation arising from the damaged endotracheal tube.

Implications:

• This case highlights the successful application of combined advanced airway techniques in managing intraoperative complications in patients with Treacher Collins syndrome.
• It underscores the importance of preparedness and specialized equipment for complex airway management in craniofacial anomalies.
• The described technique offers a potential solution for similar challenging airway scenarios in perioperative settings.