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We report the airway management of an 11-year-old boy with Treacher Collins syndrome. In three instances under general anaesthesia, ventilation via either anaesthesia facemask or supraglottic airway device proved virtually impossible except when the neck was flexed, which runs counter to what is typically observed during routine anaesthetic care. In this report, the impact of neck flexion on the patient's airway is demonstrated with images obtained on videolaryngoscopy and flexible endoscopy.

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