Fiberoptic-guided nasotracheal intubation under conscious sedation with dexmedetomidine on a patient with giant ameloblastoma scheduled for mandibulectomy

This is a case of a 54 year old ASA III mle who underwent extirpation of recurrent multiseptated mandibular ameloblastoma; with microvascular fibul free flap reconstruction. the extension of the huge mass into the floor of the mouth and anteriorly into the sub-metal area indicating probable difficult instrumentation during laryngoscopy, necessitated awake fiberoptic guided nasotracheal intubation using dexmedetomidine sedation. Anesthesia was maintained with oxigen- isoflurane at 0.8-1.5 volue percent, atracurium infusion at 0.2 mg/kg/ hour, fetanyl infusion at 1-2 mcg/kg/hour. Postoperatively, the patient remained intubated for 7 days.