• Chetan B Raval and Suleiman Khan.
• Department of Anesthesia, Al-Nahdha Hospital, P.O. Box: 937, PC: 112, Ruwi, Muscat, Oman.
• Middle East J Anaesthesiol. 2012 Feb 1;21(4):647-51.

AbstractSecuring the airway is a core skill in anaesthesia, the gold standard of which is tracheal intubation. Normally this is achieved after induction of anaesthesia. However, some circumstances demand an awake approach. Skilful airway management is critical in deep neck space infections. There is currently no universal agreement on the ideal method of airway control for these patients because this depends on various factors including available local expertise and equipment. Compromised airway is still a challenge to the anesthesiologist in spite of all modalities available. Any flaw in airway management may lead to grave morbidity and mortality. We present a morbidly obese case of submandibular abscess with difficult intubation underwent incision and drainage. Large facial [jaw] swelling, TRISMUS-limited mouth opening, edema, protruding teeth and altered airway anatomy makes airway management more difficult. The case was further complicated by morbid obesity. Chances of rupture of abscess intraorally and aspiration under GA is a major threat. During GA, there is no change in mouth opening and loss of airway under muscle relaxation, "difficult to ventilate, difficult to intubate" makes these cases most challenging. On the basis of our experience case was successfully intubated by awake fibreoptic intubation.

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