UR, a 20-year-old female student was referred on account of micrognatia and bilateral fibrous ankylosis of the temporomandibular joint (TMJ) secondary to trauma. A preoperative evaluation showed severe limitation of mouth opening and her bedside airway assessment was Mallampati class 4.The patient presented twice in the theatre for bilateral arthroplasty of the TMJ. In her first visit to the theatre, surgery was rescheduled because of failed intubation. Two weeks later, bilateral arthroplasty of the TMJ was done following a nasotracheal intubation achieved through a blind nasal technique and confirmed by fibreoptic laryngoscope under general anaesthesia with muscle relaxation. Postoperatively, the patient was noticed with airway obstruction and bleeding. Postoperative recovery was uneventful and she was discharged home on the 12th postoperative day. Management of an anticipated difficult airway and the anaesthetic considerations in bilateral arthrosplasty are discussed.
