Beyond fiberoptic: securing the airway in a child with bilateral TMJ ankylosis

Traumatic injury involving the temporomandibular joint during early childhood can progress to temporomandibular joint ankylosis. Securing the airway for corrective surgery in pediatric temporomandibular joint ankylosis is a considerable anesthetic challenge. While fiberoptic intubation is the gold standard for anticipated difficult airways, a pediatric fiberoptic bronchoscope may not be readily available. We present the anesthetic management of an 11-year-old girl with bilateral TMJ ankylosis scheduled for corrective surgery, using Glidescope^® assisted nasotracheal intubation as an alternative in the absence of a pediatric fiberoptic bronchoscope. This case demonstrates that innovative airway management strategies, including the use of a feeding tube guide, can be effectively employed in challenging situations.