Laryngeal Mask Airway-Guided Fiberoptic Tracheal Intubation After Traumatic Failed Intubation in a Neonate With Severe Arthrogryposis Multiplex Congenita: A Case Report.

Airway management in neonates with arthrogryposis multiplex congenita (AMC) presents extreme challenges due to craniofacial abnormalities, cervical rigidity, limited mouth opening, and restrictive chest wall mechanics. These patients are at increased risk of failed intubation and perioperative respiratory complications, as airway trauma may rapidly develop, causing airway edema and compromising oxygenation. Early recognition and individualized airway planning are essential to avoid repeated traumatic airway manipulation and its associated complications. In our case, a full-term male neonate with prenatally diagnosed AMC developed severe respiratory distress immediately after birth due to restrictive lungs. Multiple direct and indirect laryngoscopy attempts failed, resulting in significant airway edema and bleeding. Instead of pursuing repeated traumatic attempts, a supraglottic airway device (laryngeal mask airway (LMA)) was inserted to maintain ventilation and oxygenation. The LMA remained in situ continuously for 72 hours while airway edema subsided under intensive care monitoring. Once airway conditions improved, fiberoptic bronchoscopy-guided tracheal intubation was successfully performed through the LMA. The ENT team remained immediately available for emergency surgical airway throughout the procedure. No airway complications or pressure-related mucosal injury attributable to prolonged LMA use were observed in our case. In selected neonates with traumatic difficult airways, prolonged LMA use may safely preserve oxygenation while allowing time for careful planning of definitive airway management. Fiberoptic-guided intubation through the LMA represents a practical and minimally traumatic approach.