Crouzon syndrome: an anesthetic challenge

Crouzon syndrome is a rare hereditary disorder, characterized by craniosynostosis.Management of difficult airway is challenging because of craniofacial abnormalities. Presentation during adulthood is rare. We describe the case of a 37-year-old man with a known case of Crouzon syndrome who was posted for fixation of humerus fracture. The patient was unique because of the presence of kyphoscoliosis with severe restrictive lung functions, atlantoaxial dislocation, and mental retardation, having almost all features of the syndrome. Anesthesia plan A was to use laryngeal mask airway proseal as the patient had adequate mouth opening. Nasal fiberoptic bronchoscopy was contraindicated and regional nerve block was not a feasible option. Plan A was not successful because of obstructed breathing pattern. Plan B of oral fiberoptic bronchoscopy-guided intubation with good airway anesthesia andsedation was successfully managed in the next attempt.