Management of Maxillofacial trauma is a challenging task for an anaesthesiologist. It requires a prompt and skillful response from the anaesthesia team. Bilateral parasymphsial fracture, condylar fracture, fracture of zygoma, flattening of face, moderate bleeding and derranged occlusion are the main cautionary pointers of difficult airway. Emergency airway management should be done by a team led by an anaesthesiologist. A difficult airway cart along with resuscitation trolley should be ready. Plan A should be direct laryngoscopy and manual in line stabilization. Video laryngoscope if available should be preferred. Plan B must include fiberoptic, optical and lighted stylets and airway rescue supraglottic devices. Surgical access should be used as backup plan C. Elective management for definitive surgery should be based on specific maxillofacial trauma, surgical approach, associated inflammation and need of prolonged mechanical ventilation in postoperative period.

A primigravida, aged 22 years, at 39th gestational week was hospitalized with dyspnea since onset of labor. On systemic evaluation and echocardiography, she was diagnosed to have congenitally corrected transposition of the great arteries (CCTGA) along with severe pulmonic stenosis and bidirectional ventricular and atrial septal defects. A multidisciplinary team provided initial symptomatic management, stratified the risk and planned for a cesarean section. A low-dose combined sequential spinal-epidural anesthesia with invasive monitoring was used which provided excellent surgical condition with stable intraoperative and postoperative hemodynamics.

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u Majority of the patients with pan facial fractures have severe limitation of mouth opening, particularly involving the zygoma and the angle of mandible. u Airway management is challenging in these cases, especially if mouth opening is less than 20 mm 1 . u Awake nasal fiberoptic intubation is the standard technique of airway management in these patients posted for reduction of faciomaxillary and mandibular fractures. u However, in case of failed fiberoptic due to bleeding, particularly in panfacial trauma, the only option of securing the airway left is the surgical one. u Blind nasal intubation can act as a bridge between a failed fiberscope attempt and a surgical airway, but it has become a dying art in present scenario 2 .