The Laryngeal Mask Airway for exchange of a nasal for an orotracheal tube in a patient with Treacher Collins syndrome

A new method of exchange of nasotracheal to orotracheal tube, using the Laryngeal Mask Airway (LMA), in a patient with difficult airway, is described. A 36-year-old woman with Treacher Collins syndrome was scheduled for a malar apatite cutting and a chin-level osteotomy. It was necessary to exchange a nasotracheal tube for an orotracheal tube during the operation. An LMA was inserted while the nasotracheal tube was left in place; a new tube was inserted in the LMA, then a fiberoptic laryngoscope (fiberscope) was inserted through these devices. The nasotracheal tube cuff was deflated, and the fiberscope was inserted into the trachea alongside the nasotracheal tube. The nasotracheal tube was removed, and the oral tube was then advanced into the trachea.