Anaesthetic Management of Nablus Mask Like Facial Syndrome: A Difficult Airway Case

Dr Vidhya Deshmukh, Dr Bhakti Patel

Abstract: Introduction: Nablus mask-like facial syndrome (NMLFS) is an extremely rare genetic disorder characterized by distinctive craniofacial dysmorphism and multiple congenital anomalies. From an anaesthetic perspective, the presence of micro-retrognathia, restricted mouth opening, macroglossia, restricted temporomandibular and cervical mobility, and altered upper airway anatomy places affected children at high risk for difficult mask ventilation and tracheal intubation. Published literature describing perioperative airway management in NMLFS is limited, making individual case reports valuable for guiding clinical practice. Case Description: We report the case of a two-year-old male child with genetically confirmed NMLFS who presented for elective left blepharoptosis correction. Preoperative airway evaluation revealed multiple predictors of difficult airway, including Glottic visualisation and restricted mouth opening, macroglossia, high-arched palate, short neck, and restricted cervical mobility. Anticipating airway difficulty, a comprehensive, stepwise airway management plan was implemented. Following inhalational induction with maintenance of spontaneous ventilation, both direct and video-assisted laryngoscopy failed due to poor glottic visualization. Subsequent nasal fibreoptic intubation attempts were unsuccessful. The airway was ultimately secured using a supraglottic airway?guided fibreoptic intubation technique, which allowed effective ventilation and atraumatic tracheal intubation without hypoxic compromise. Conclusion: This case highlights the significant anaesthetic challenges associated with NMLFS and underscores the importance of meticulous preoperative assessment, anticipation of difficulty, and early escalation to rescue airway techniques. Supraglottic airway?assisted fibreoptic intubation proved to be a safe and effective strategy following failed conventional approaches. Reporting such cases adds to the limited evidence base and reinforces key principles of paediatric difficult airway management aimed at optimizing perioperative safety in rare craniofacial syndromes.

Keywords: Nablus mask-like facial syndrome, difficult airway, fibreoptic intubation, supraglottic airway, paediatric anaesthesia

How to Cite?: Dr Vidhya Deshmukh, Dr Bhakti Patel, "Anaesthetic Management of Nablus Mask Like Facial Syndrome: A Difficult Airway Case", Volume 15 Issue 8, August 2026, International Journal of Science and Research (IJSR), Pages: 1882-1886, https://www.ijsr.net/getabstract.php?paperid=MR26823210506, DOI: https://dx.doi.org/10.21275/MR26823210506

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