Temporomandibular joint ankylosis is an anticipated difficult surgery especially when it is performed in children and same is in the intubation scenario too.TMJ ankylosis creates a difficult situation on the operating table for a surgeon. When it comes to anesthetist the awake fiber optic intubation is the safest approach to secure an airway in such a case. This is a case of unilateral temporomandibular joint ankylosis scheduled for interpositional arthroplasty. But due to non-availability of adequate sizedfiber optic scope, a flexible ureteroscope to facilitate nasotracheal intubation was used.For the interpositional arthroplasty a costocondral graft was used for this case.
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