Introduction: Upper airway distress associated with craniofacial anomaly has been reported widely. An antenatal scan of craniofacial anomaly should alert the attending team to prepare for respiratory distress in any neonate following delivery. Additionally, a stepwise algorithm is imperative to manage the difficult airway in children with craniofacial anomalies. Aim: To outline a case of difficult airway in a newborn with a craniofacial anomaly. Case study: A premature neonate, born at 36 weeks, was referred to the otorhinolaryngology team following the failure of intubation. Guedel oropharyngeal airway was inserted, and temporarily airway was managed with non-invasive ventilation. However, tracheostomy was subsequently performed, while the neonate was ventilated via face mask. Discussion and conclusion: Prompt management is of dire importance in handling a newborn with craniofacial anomaly in respiratory distress. Guedel oropharyngeal airway is a temporary measure used to secure the airway, while tracheostomy is performed.

tracheostomy, Guedel airway, upper airway obstruction, neonatal airway management, difficult airway