Endotracheal intubation and Treacher Collins syndrome

Abstract

The patient, a 4 year old black boy, weight 15 kg, height 102 cm, congenitally deaf and mentally retarded because of Treacher Collins syndrome, was scheduled for a canaloplasty. The patient was anesthetized with halothane, nitrous oxide and oxygen via a nonrebreathing system. Direct laryngoscopy was attempted, but nothing anterior to the esophagus was visualized. In addition, laryngoscopy caused upper airway obstruction, which was relieved only by removing the laryngoscope. A variant of blind nasotracheal intubation with a 5 mm tube was successful. The tube was placed in the nose, and connected to the anesthesia apparatus, so that it was functioning as a nasal airway through which anesthesia was maintained. The index and middle fingers of the left hand were used to palpate the epiglottis and the tube was directed between the two fingers into the larynx with little difficulty and no coughing or reaction by the patient.