Fibreoptic-guided Nasal Intubation for Airway Management in Severe Microstomia Secondary to Pyostomatitis Vegetans: A Case Report

Pyostomatitis vegetans is an uncommon chronic inflammatory mucocutaneous disorder frequently associated with inflammatory bowel disease. Progressive ulceration and fibrosis of the oral mucosa may lead to severe microstomia, creating significant challenges for airway management during anaesthesia. A 10-year-old female with pyostomatitis vegetans presented with progressive scarring of the oral cavity resulting in severe microstomia and functional impairment. She was scheduled for corrective plastic surgery. Preoperative airway assessment revealed an inter-incisor distance of approximately 0.5-0.75 cm, making conventional laryngoscopy impossible and predicting both difficult intubation and potential difficulty in ventilation. A multidisciplinary team involving anaesthesiology, plastic surgery and otorhinolaryngology specialists formulated a detailed airway strategy, with preparations made for emergency surgical airway access if required. The patient underwent fibreoptic-guided nasal intubation while maintaining spontaneous ventilation following careful airway preparation and inhalational induction. The airway was secured successfully without complications. Intraoperative monitoring demonstrated stable haemodynamic and respiratory parameters throughout the procedure. Following an uneventful surgical course, the patient was extubated safely and observed postoperatively in the paediatric intensive care unit. The present case highlights the importance of meticulous preoperative evaluation, multidisciplinary planning, preservation of spontaneous ventilation and fibreoptic-guided nasal intubation in the management of anticipated difficult airways caused by severe microstomia. The rarity of pyostomatitis vegetans-associated microstomia and its successful airway management in a paediatric patient underscore the clinical significance of the present report.