Airway management of an adult patient with palatal defect is a challenging case to Anesthesiologist. We report an adult patient who is an operated case of nasopharyngeal Angiofibroma posted for palatal defect (3.5*4.5 cm) repair. It was a major surgery lasted for 10 hours involving free flap from radial aspect of forearm along with radial artery and repositioning on palatal defect and anastomosis with facial artery. Challenges involved in this case management were airway, analgesia and fluid electrolytes . Intraoperative period was uneventful. Patient was electively shifted to ICU for prophylactic ventilatory support with ETTube in situ post procedure because it being a major surgery with compromised airway with poor pharyngeal reflexes, copious secretions, bite block. Patient was postoperatively managed with adequate analgesia, sedation and relaxation and was extubated on 3rd postoperative day. The details would be discussed later.
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