Management of Anticipated Difficult Airway in A 5 – Year - Old Child with Embryonal Rhabdomyosarcoma of the Uvula in a Resource Poor Environment

Abstract

Rhabdomyosarcoma is a rare tumour of the oral cavity, with the embryonal subtype being the most common. It typically presents in children under the age of 10 and has a predilection for the head and neck region, although involvement of the oral cavity is less frequent. Airway management in paediatric patients presents inherent challenges due to the unique anatomical and physiological characteristics of this age group. These challenges are further compounded in cases where a difficult airway is anticipated. To ensure patient safety and effective airway management, thorough history-taking and physical examination are essential, particularly in patients with noticeable anatomical abnormalities of the airway. Close collaboration between the anaesthesia and surgical teams is crucial to ensure that all relevant clinical concerns are identified, understood, and addressed. This collaboration facilitates comprehensive preoperative planning, especially when managing anticipated difficult airways. We present the case of a 5-year-old boy with residual embryonal rhabdomyosarcoma of the uvula, scheduled for debulking surgery. Airway management proved challenging, requiring two intubation attempts and a modification of the initial technique. The surgery and postoperative recovery were uneventful. This case highlights the practical application of conventional techniques in managing paediatric difficult airway cases within a resource-limited setting and underscores the importance of adaptability and multidisciplinary planning.