Melanocytic neuroectodermal tumor of infancy: A plethora of airway nightmares!

Melanocytic neuroectodermal tumor of infancy (MNTI) is a rare, benign neoplasm involving the jaw. It is characterized by a high rate of recurrence and locally aggressive enlargement. This condition often leads to facial asymmetry and difficulty in airway management during surgical excision. Due to its rarity, there are no established guidelines for the perioperative management of MNTI. We describe the successful airway and anaesthetic management of three paediatric cases of MNTI. These cases highlight the complexities of airway management in paediatric patients with limited oral space and facial asymmetry. The anaesthetic approach prioritized meticulous preparation for potential difficult airway scenarios, including obtaining high-risk consent, assembling appropriate equipment, and premedication with ketamine and glycopyrrolate. Inhalational induction with sevoflurane was employed, and video laryngoscopy was used to aid intubation. Muscle relaxation and analgesia were carefully managed intraoperatively, with an emphasis on minimizing opioid usage postoperatively. The cases illustrate the importance of teamwork and multidisciplinary collaboration in managing challenging paediatric airway scenarios. This series contributes to the understanding of anaesthetic considerations in MNTI cases and underscores the significance of thorough preparation and coordination in optimizing patient outcomes.