[A case of Marshall-Smith syndrome].

Marshall-Smith syndrome (MSS) is a rare clinical disorder, characterized by accelerated skeletal maturation, facial anomalies, failure to thrive and death in early infancy due to respiratory complications. We experienced the difficult airway case with MSS. A 4-year-old boy underwent tenosynovectomy for the snapping finger. Although his upper airway was diagnosed as almost normal on the fiber-optic laryngoscope examination, he frequently showed pharyngeal collapse during sleep. Anesthesia was induced and maintained with N2O-O2-sevoflurane using oral-airway without muscle relaxants. But, when we inserted the laryngoscope in order to clarify the existence of the difficult intubation, we could only see a part of the epiglottis. We concluded that we must treat MSS as difficult airway and intubation, even if in the mild case of MSS.