Tissue Expanders are used in the reconstruction of various defects when there is insufficient adjacent tissue for direct closure. It can be utilised for scar revision, tissue defects, breast reconstruction after mastectomy and correction of an underdeveloped breast. When the procedure involves the head or neck, it is in proximity to the airway and may make endotracheal intubation difficult. We present a nine year old male child with post burns hypertrophic scar on the right side of the face. A rectangular silicone tissue expander was inserted in the supraplatysmal plane on the right antero lateral plane of the neck as the hypertrophic scar was on the right side of the face. After serial expansion for six months, he was posted for rotational flap cover of the post excision defect using the expanded skin. Due to the placement of the tissue expander on the neck, his mouth opening and neck movements were restricted. He could not lie in supine position due to the airway obstruction. This case of anticipated difficult airway created by the tissue expander was managed by treating the swelling like a huge mass on the anterior part of neck. With detailed and meticulous planning, the case was managed well.
