Perioperative Anaesthesia Challenges in a Difficult Airway Case of a Turricephaly Child Posted for Fronto-orbital Advancement and Remodelling: A Case Report

Turricephaly is a rare craniosynostosis characterised by premature fusion of the coronal sutures, resulting in a tower-shaped, elongated skull. This abnormal skull morphology presents anaesthetic concerns due to associated craniofacial deformities that complicate airway management, increase the risk of raised intracranial pressure and pose challenges in vascular access, fluid management and control of intraoperative blood loss. Present case is of a 13-year-old girl with turricephaly who underwent fronto-orbital advancement and cranial remodelling. An anticipated difficult airway was encountered, requiring multiple intubation attempts. Intraoperative anaesthesia care focused on securing the airway, maintaining normocapnia, invasive monitoring, proper fluid management, prevention of hypothermia and management of intraoperative blood loss with transfusion of blood products. Postoperatively, the patient was electively intubated and transferred to the Paediatric Intensive Care Unit (PICU) and kept on a ventilator overnight with appropriate sedation and analgesia. The patient was extubated the next day. This case highlights the importance of thorough preoperative assessment, vigilant intraoperative management including fluid management and transfusion strategies, maintenance of normothermia and meticulous postoperative care in achieving a successful outcome in such complex craniofacial surgical cases.