The peroperative management of a 4 1/2 yr old child having bilateral recurrent temporomandibular joint (TMJ) ankylosis and obstructive sleep apnoea (OSA) is presented here. From the anaesthesiologist's point of view, the patient demands special considerations as regards difficulty in intubation, high sensitivity to all central depressant drugs, awake extubation, and post-operative maintenance of a clear airway. It is to be concluded that these conditions call for strict adherence to the basic principles of airway management and close observation extending into the post-operative period.