Marshall syndrome is characterized by mid-facial hypoplasia, high myopia, and upper airway malformations ; consequently, endotracheal intubation can be difficult. In the present case report, we utilized cephalography to evaluate the potential difficulty of endotracheal intubation prior to performing dental treatment in a patient with Marshall syndrome. Our previous study demonstrated that the retracted position of the mandible, a short mandible length, and a low hyoid bone position could be predictors of a difficult airway. We also analyzed the patency of the nasal tract on a CT image. In this manner, we were able to confirm that the mandible position was not abnormally retracted from the ANB angle measure of less than 3 SD or the facial angle measure of more than 3 SD ; thus, the mandible was not small enough to be categorized as a difficult airway based on a Gn-Cd measure of −1 SD. The position of the hyoid bone was also not too low, since the MP-H was −1 SD. General anesthesia was induced with nitrous oxide, sevoflurane, remifentanil, and rocuronium. We were able to intubate the patient smoothly through the predetermined nasal tract. The procedure was uneventful, and the patient was discharged from the hospital on the day of surgery. In conclusion, preoperative evaluations of difficult airways and intubation tract planning based on anatomical evaluations of cephalograms and CT images can be useful for securing safe airway management in patients with Marshall syndrome.
