Metatropic dysplasia (MD) is a rare form of skeletal dysplasia that requires frequent anesthetics for surgical and imaging procedures. At the time of writing, we have ~65 patients cared for at Nemours Children’s Health, Delaware Valley. This is the largest number of patients with metatropic dysplasia cared for at any center. Most patients have difficult airway, which means they are either difficult to ventilate using a face mask, difficult to intubate, or both. Metatropic dysplasia also gives rise to a rigid chest cavity, contributing to restrictive lung disease in addition to their smaller thoracic cavity. When caring for patients with metatropic dysplasia, the anesthesia provider should be prepared to manage a difficult airway.