Anaesthetic management of congenital fusion of the jaws in a neonate.

Fusion of the jaws in the neonate is a very rare congenital anomaly which may be associated with other congenital defects such as aglossia, facial hemiatrophy or retrognathia. Ventilatory management for surgical separation of the fused jaws presents severe problems. In a recent case of a neonate with almost completely fused jaws requiring general anaesthesia, we used subanaesthetic doses of ketamine in combination with an insufflation technique. It took 45 minutes to reach the surgical stage of anaesthesia due to misplacement of the nasotracheal tube through an unsuspected cleft palate towards a gap between the jaws, a previously unreported combination of complications.