**5.1 Introduction**

There is a wide spectrum of head and neck surgeries ranging from major complex operations to simple minor day care surgical procedures [10].

It is not uncommon for head and neck surgery to affect the airway or to require changing the airway during the operation. For that reason, it is important to have a close and good cooperation between the theater teamwork (surgeons, anesthetists, anesthetic assistants, and nurses [10].

In the current practice now, there is wide range of diverse practice for postoperative airway management of head and neck patients. For example, some will do temporary tracheostomy for almost all head and neck free-flap reconstructions whereas others will manage the same case by overnight ventilation followed by extubation next day [11].


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

assessment).

neck [12].

**General factors:**

**5.2 Factors affecting the strategy of airway management**

**5.3 How to predict postoperative airway difficulty**

airway obstruction postoperatively.

will be very useful [12].

mandible and age above 55 years old.

**5.4 Management strategy for difficult airway**

requirements that are necessary and should be met.

agents may result in airway obstruction leading to hypoxia [12].

**During induction:**

**Surgical factors:**

**General management:**

airway [12] (**Table 3**):

risk of postoperative airway obstruction.

• A preoperative detailed history of the patient is very helpful to decide the best management of the airway post operatively. (Please refer to the pre-operative

• Careful preoperative examination of the face, mouth, pharynx, larynx and

Causes of airway obstruction postoperatively are provided in **Table 2** [12].

1.If initial intubation is difficult then extubation may also be difficult.

2.Trauma to the airway will lead to oedema which may cause life-threatening

3.Obese patients and, or patient with obstructive sleep apnoea (OSA) are at high

4.Emergency patients or patient with gastro-esophageal reflux disease are at risk of aspiration postoperatively, a stomach decompression with nasogastric tube

5.Patients with unrelieved trismus (e.g. because of fibrosis) will need the use of

If the mask ventilation at induction is difficult, this may predict difficulty during emergence [12]. The difficulty in mask ventilation at induction is mainly due to airway abnormality (tumor), OSA, facial asymmetry, Mallampati 3 or 4, receding

The airway in some of head and neck surgery can be changed from the preoperative state due to surgical intervention [11]. e.g. Operations on the tongue, pharyngoplasty, palatoplasty, tonsillectomy, operations on the cervical vertebrae, oedema following maxillofacial surgery and any major head and neck surgery.

Before safe extubation of the difficult airway we should consider number of

The following techniques are suggested for a wake extubation of the difficult

Excessive use of opioid and incomplete reversal of neuromuscular blocking

Therefore, quantitative neuromuscular monitoring is recommended.

an oropharyngeal airway or bite block (e.g. rolled gauze).

#### **Table 2.**

*Causes of postoperative airway obstruction.*
