Cleft Lip, Cleft Palate, and Craniofacial Reconstruction — WACS Viva & Clinical Scenarios (Plastics & Dental)

Exam-style cleft lip, cleft palate, and craniofacial reconstruction viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 3-month-old infant weighing 4.5 kg is presented for elective unilateral cleft lip repair (Millard rotation-advancement). The hemoglobin is 9.8 g/dL. Evaluate the patient's fitness for anaesthesia based on clinical and physiological criteria (including the 'Rule of 10s'). Outline your complete anaesthetic management from induction to extubation, including specific regional analgesia techniques.
• SCENARIO 2: A 10-month-old infant weighing 8 kg is undergoing cleft palate repair. Following insertion of the Dingman mouth gag and suspension, the end-tidal CO2 trace suddenly drops from 38 mmHg to 10 mmHg, peak airway pressure rises from 16 cmH2O to 35 cmH2O, and SpO2 drops to 88%. Detail your immediate diagnostic algorithm and corrective actions for this intraoperative shared-airway crisis.
• SCENARIO 3: A 4-month-old infant with Pierre Robin sequence (severe micrognathia, glossoptosis, and wide cleft palate) is scheduled for cleft palate repair and tongue-lip adhesion. He has a history of severe subcostal recession and desaturation while sleeping supine. Describe your comprehensive airway management plan for induction, intubation, and safe extubation.
• SCENARIO 4: A 9-month-old infant is scheduled for cranial vault remodeling for sagittal craniosynostosis (scaphocephaly). The expected surgical duration is 4 hours with significant bone osteotomies. Detail your preoperative blood ordering, invasive monitoring setup, intraoperative fluid and blood management, and specific strategies to detect and treat venous air embolism.