Unanticipated difficult airway due to post-traumatic fibrosis in a delayed maxillofacial surgery: A case report

This case report describes an unanticipated difficult airway during anesthesia in a 25-year-old male who developed fibrosis-induced trismus following maxillofacial trauma. The patient presented one month after injury for corrective surgery; despite apparently adequate pre-anesthetic airway parameters, induction revealed near-complete trismus caused by post-traumatic fibrotic changes. Endotracheal intubation was accomplished using a bougie-assisted laryngoscopic technique. Intraoperatively, a Heister jaw opener was applied as an airway-facilitation adjunct rather than a corrective device, increasing the interincisor distance from 2.5 cm to 3.5 cm and allowing surgical access. Definitive reconstruction was deferred because of extensive fibrosis. This case highlights the need to anticipate fibrosis-related airway difficulties even when conventional airway assessments appear normal and underscores the value of preoperative imaging and multidisciplinary planning. Mechanical adjuncts such as the Heister jaw opener may provide useful intraoperative assistance in selected cases of post-traumatic trismus.