Apert syndrome (AS) is an autosomal dominant disease associated with several craniofacial and limb deformities. Craniofacial deformities in AS patients requiring surgery are usually associated with difficult airway management. We report a case of a 21-year-old male patient, ASA III, with AS, who had a mandibular fracture and reconstruction was planned. The patient had all the features of AS. He had no comorbidities such as hypertension and diabetes mellitus. Awake intubation with fiberoptic bronchoscope was planned. In these patients with AS, intravenous access might also be difficult due to limb deformities. Some surgical procedures make intravenous access even more difficult. Rarely, if intravenous access is judged to be mandatory in an emergency, intraosseous or intramuscular access may be an alternative. Abbreviations: AS - Apert syndrome; ED - emergency department; MSCT - Multislice Computerized Tomography Key words: Apert syndrome; Acrocephalosyndactylia / diagnostic imaging; Acrocephalosyndactylia / pathology; Syndactyly / pathology; Maxillofacial reconstruction, Airway management Citation: Purwoko P, Azhar A, Permana SA. Difficult airway management in Apert syndrome for maxillofacial reconstruction: a case report. Anaesth. pain intensive care 2021;26(1):119-122. DOI: 10.35975/apic.v26i1.1781 Received: October 27, 2021, Reviewed: November 11, 2021, Accepted: November 14, 2021