The nerve supply of the cleft lip, our modification of the block, and possible problems with this technique are discussed. This study confirms the utility of this block for postoperative analgesia. Further studies are required to apply this innovative, safe, and economical modification of anesthesia for cleft lip surgery.

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We report an unusual case of electric burns suffered by a 15-yr-old boy. The patient's neck had come in contact with a high voltage broken electric wire and by reflex he had pulled it away with his right hand. He presented with a tracheo-cutaneous fistula with a right-sided pneumothorax. Emergency airway management included insertion of a tracheostomy tube through the traumatic opening in the neck and insertion of an intercostal tube drain. When the diagnostic endoscopy revealed an externally communicating tracheo-oesophageal fistula, protecting the lower airways from gastrointestinal contamination became a priority. The patient was anaesthetized through the traumatic tracheostomy and a formal low tracheostomy was done below the level of the fistula. The patient then underwent oesophageal reconstruction with a stomach free flap. Tracheo-oesophageal-cutaneous fistula is a rare presentation of electric burns. The anaesthetic management of the emergency difficult airway in any penetrating neck injury can be extremely difficult requiring a carefully planned multi-disciplinary approach.

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ConclusionThe lateral technique of insertion of the Classic TM LMA along either the right border or the left border of the tongue is comparable in terms of the fibreoptic grading and the time taken for successful insertion. However, left side technique is easier as per the operator, requires fewer number of attempts, has lesser incidence of sore throat after 2 hours.