# Orbital fistula tract - a case report of a rare cause of impossible facemask ventilation

## TL;DR

This case report describes a rare orbital fistula that caused challenges during facemask ventilation, highlighting the importance of communication and preparation in anesthesia.

## Contribution

A case report of a rare orbital fistula causing impossible facemask ventilation, emphasizing the importance of team communication.

## Key findings

- An orbital fistula tract was identified as a rare cause of difficult facemask ventilation.
- Preparatory errors in patient assessment and anaesthetic preparation were found to contribute to the problem.
- Effective team communication is crucial in managing such rare and complex cases.

## Abstract

Adequate facemask ventilation during induction of anaesthesia is a key aspect of patient safety. Difficulties can therefore be life-threatening for the patient.

The case presented here illustrates a rare cause of an orbital fistula that led to a serious problem during facemask ventilation and demonstrates why team communication is so important.

Preparatory errors in patient assessment and anaesthetic preparation were identified as sources of error.