An a Esthetic Management of a Case of Xeroderma Pigmentosum With Squamous Cell Carcinoma Posted for Wide Excision and Grafting Pre Senting With a Difficult Airway

Abstract

BACKGROUND: Xeroderma Pigmentosum (XP) is a rare autosomal recessive disorder characterized by hypersensitivity of the skin to UV radiation. These patients show a failure to repair UV induced DNA lesions caused by Nucleotide Excision Repair mechanism. They develop neoplasms at an early age and require repeated surgeries. METHODOLOGY: We report an 18 year old female patient with XP who presented with squamous cell carcinoma over parotidectomy site and was scheduled for wide excision and skin grafting. During Pre anesthetic checkup, difficult air way was anticipated and so all the available airway gadgets were kept ready. General anesthesia with propofol was planned. OBSERVATION: After adequate preparation, counseling regarding anesthetic plan of action and high risk consent, propofol given followed by succinylcholine. Patient had severe restriction of mouth opening when compared to preoperative period probably due to masseter spasm after succinylcholine. Placing an I-Gel by an experienced anesthesiologist helped in the successful management of this case. CONCLUSION: Newer supraglottic devices like I-Gel may be considered as a safer alternative in such difficult situations.