**3.2 General important points should always be noticed**


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**Figure 5.**

*Airway Management in Head and Neck Pathology DOI: http://dx.doi.org/10.5772/intechopen.94498*

with some special FiO2 settings).

ETT intubation in those cases.

B. **Jet Venturi ventilation:**

1 cm down to the level of the stenosis.

laryngoscope or attached to laryngoscope.

laryngoscope) or infra glottic jet ventilation.

*Tritube: (Tritube, Ventinova medical, Eindhoven, the Netherlands).*

3.**In case of using surgical LASER:** a LASER-protected tube must be used. In case we use jet ventilation or apneic technique (both are safe for the LASER

4.**In case of the patient has a tracheostomy tube:** 5.5–6.0 mm Endo Tracheal Tube (ETT) inserted at the tracheal stoma into the trachea, **LASER** protected ETT should be used in case we use LASER. Using (apneic technique) if airway surgery is performed distal to the tracheal stoma site, applying frequent (reinsertion technique) of stomal ETT to give Oxygen in between the treatment.

5.Mask induction with anesthetic agents is the suitable method of airway management for endoscopic treatment of **subglottic/tracheal stenosis**, or using total intravenous anesthesia (TIVA) then using jet ventilation. Avoid using

6.In case of scar formation because of **tracheostomy** was done in a patient with subglottic/tracheal stenosis, then the airway interning should be done at least

In general, lesions present at the anterior 2/3 (membranous vocal folds) of the larynx can be easily exposed and treated with size 5.5 mm or smaller micro laryngeal ETT. Lesions at the posterior 1/3 (vocal processes and posterior commissure/ arytenoids region) of the larynx we can use one of those techniques (**Figure 5**):

A. **Oral intubation** using a small long ETT size: 5.0 mm or 5.5 mm microlaryngoscopy tube (MLT) with a length (30 cm length) with adult tube's balloon that makes good airway sealing. Or using Tritube (**Figure 3**), an ultrathin endotracheal tube (outer diameter 4.4 mm/inner diameter 2.4 mm).

1.Supra-glottic jet Venturi needle (**Figure 6**) Applied through port within

2.Tracheal Jet ventilation (where the tip of the jet is near the tip of the

**3.3 Anesthesia technique used in case of micro-laryngoscopy (MLS)**

*Special Considerations in Human Airway Management*

**2.5 Airway endoscopy and trans-nasal tracheoscopy (TNT)**

**3. Airway management for benign laryngeal surgery**

**3.2 General important points should always be noticed**

another plans become necessary.

It is a form of indirectly visualizing the airway and larynx in which the clinician does not directly view the lower part of the airway or larynx [4]. Instead, it is

*Example of fiber optic tracheoscopy on a tracheal stenosis patient under local anesthesia showing the carina* 

Working with our anesthesia colleagues at one place which is the upper airway passages is one of the most important (and often neglected) aspects of successful laryngeal operation. Lack of cooperation and pre-surgical planning with the anesthesiology team can make simple micro-laryngoscopy case into an airway crisis [1]. Benign laryngeal tumors are more common than the malignant one. Phono-surgery is used to excise most of those tumors whether is a vocal cord cyst, polyp, nodule, etc.

1.**Different plans + proper equipment's**: A good management plan for taking care of the patient's airway should be negotiated with the anesthetist before going to the surgery. An excellent plan (plan A), also another strategy (plans B and C) must be ready so that the airway management is algorithmic and automatic, as opposite to unplanned reaction. Before taking the patient into the operating theater, both the operating surgeon and the anesthesia team must have the right equipment in the room, opened, and "ready to use" if

2.**Positioning**: for optimal laryngoscopy exposure the patient put in the "sniffing positioning," head extended on the neck, and the neck flexed on the chest [6].

visualized with fiber optic or digital laryngoscopes inserted trans-nasally. The images from the scope can be displayed on a monitor for the clinician, patient and others to view at the time of the procedure; it can also be recorded. Experienced clinicians can also perform it on a wake tracheoscopy using local anesthesia on cooperative patients. They are an essential tool for identifying and planning strategies for management of difficult airway cases [5] (**Figure 4**).

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**3.1 Introduction**

**Figure 4.**

*(a) and stenosed part of the trachea (b).*

