Managing a Complex Pediatric Airway Affected by Venolymphatic Malformation of the Face: A Case Report

We present a case of a two-year-old male child with a progressive venolymphatic malformation on the right cheek, resulting in facial asymmetry and mass effect, scheduled for mass excision under general anesthesia. The preoperative assessment indicated a potential for difficult mask ventilation and intubation due to the deviation of the mouth. Airway management strategies included two-hand mask techniques, appropriately sized masks, supraglottic airway device (SGAD) insertion during spontaneous respiration, video laryngoscopy, and awake fiberoptic intubation. During induction, an SGAD (i-gel no. 2) was successfully placed under spontaneous breathing, and after checking the adequacy of ventilation, endotracheal intubation with muscle relaxation was done. The surgery proceeded without complications, and the patient was extubated in the postoperative period. This case emphasizes the importance of successfully managing airway challenges through individualized planning in complex pediatric airways, especially in patients with facial malformations.