Airway Management in a Child with Large Frontonasal Encephalocele: Utility of a Small-sized Face Mask

A bstract Frontonasal encephalocele is a rare variant of neural tube defect that usually presents with swelling over the face, requiring surgical repair. Anesthetic concern in such cases includes anticipated difficult bag-mask ventilation owing to the location of the pathology, which is more challenging in a non-operating room anesthesia (NORA) environment. We report the case of a 1-year-old male child who presented with a large frontonasal encephalocele for brain magnetic resonance imaging (MRI) under general anesthesia prior to surgical intervention. The swelling over the face prevented placement of a normal-sized face-mask and bag-mask ventilation. The limited access of equipment in the MRI suite and expert help at the remote location further exaggerated the challenge. Alternate strategies and meticulous planning helped secure the airway, and the procedure was uneventful. Difficult airway management is more challenging in NORA setups with limited access to equipment and expert help. Proper planning and preparation are crucial in such limited-resource facilities to avoid catastrophe.