**2.1 History and clinical examination**

An ideal pre-operative assessment starts with a complete history & physical examination, requisite investigations, analysis of the extent of lesion, considerations for concurrent radio-and/or chemotherapy and a multidisciplinary team discussion on the plan for airway and pain management.

Symptoms suggestive of airway obstruction should be checked during history taking:


Some important questions that must kept in mind for every patient coming to the operating room:


**129**

**Figure 2.**

*AS a grading used for predicting anesthesia risk.*

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

or more indicate easy intubation.

atlantoaxial junction.

(HNC) have smoking history.

**2.2 Pre-operative imaging and endoscopy**

intubation (**Figure 2**).

and liver.

(**Table 1**).

be enough room for the tongue to move into the mandibular space and direct laryngoscopy will be easy. If this space is small, the larynx is usually located anteriorly, and intubation will be more difficult. In general, 2 fingerbreadths

4.Ability to assume sniffing position is a predictive indicator for a relatively straight axis to the glottis. The sniffing position is considered as a moderate flexion of the patient neck on his chest and extension of his neck about the

A meticulous physical examination of the patient must be done to check for vital parameters, pallor, icterus, and features suggestive of fluid overload, raised jugular venous pressure, generalized lymphadenopathy, metastasis, body mass index and any tenderness in the spine. Appropriate work-up must be done to rule out distant metastasis in the most common sited such as lungs, lymph nodes, spine, brain

Routine preanesthetic assessment clinic (PAC) tests such as a complete blood workup, ECG, echocardiography, chest radiography, liver & renal function tests and serum electrolytes must be done for all patients. Patient should also be advised for smoking cessation as a high number of patients with head and neck cancer

Patients should also be evaluated for any pre/concurrent radio - chemotherapy. Preoperative radiotherapy, this can give rise to difficult laryngoscopy, difficult

Computerized tomography (CT) is a very good diagnostic tool with excellent Risk–Benefit Ratio. It is readily accessible, with faster image acquisition. One of the advantages of CT is that it can also be extended to include other sites of the body for staging purposes especially in cancer cases. Thin Slices, high resolution image acquisition allows high quality multiplanar reconstruction (**Figure 3**). Drawbacks of CT include exposure to ionizing radiation, inferior soft tissue contrast when compared to MRI, renal failure secondary to injection of iodinated contrast medium

**Figure 1.** *Mallampati classification.*

*Special Considerations in Human Airway Management*

discussion on the plan for airway and pain management.

delayed with supraglottic or subglottic tumors.

An ideal pre-operative assessment starts with a complete history & physical examination, requisite investigations, analysis of the extent of lesion, considerations for concurrent radio-and/or chemotherapy and a multidisciplinary team

• Hoarseness: it can be an early manifestation of glottic carcinoma but is often

• Stridor: inspiratory stridor could be suggestive of a subglottic lesion, expiratory

• Dyspnea: flow volume loops are very helpful in differentiating between dyspnea

Some important questions that must kept in mind for every patient coming to

1.Mouth opening: mouth opening of around 5–6 cm is considered with in normal limits at least 3 cm mouth opening is required for successful

2.Mallampati test: has been correlated with ease of laryngoscopy. This assessment alone can provide valuable and important information about the size of tongue in relation to oral cavity size and is a useful predictor of intubation

3.Size of the mandibular space: it is the space from the inner side of the submentum to the hyoid bone. A distance greater than 6 cm means that there will

Symptoms suggestive of airway obstruction should be checked during

stridor a supraglottic lesion, and biphasic stridor a glottic lesion.

caused by upper airway obstruction or due to pulmonary disease.

• Dysphagia, or odynophagia: may indicate pharyngeal problem.

**2.1 History and clinical examination**

history taking:

the operating room:

laryngoscopy.

difficulty (**Figure 1**).

**128**

**Figure 1.**

*Mallampati classification.*

be enough room for the tongue to move into the mandibular space and direct laryngoscopy will be easy. If this space is small, the larynx is usually located anteriorly, and intubation will be more difficult. In general, 2 fingerbreadths or more indicate easy intubation.

4.Ability to assume sniffing position is a predictive indicator for a relatively straight axis to the glottis. The sniffing position is considered as a moderate flexion of the patient neck on his chest and extension of his neck about the atlantoaxial junction.

A meticulous physical examination of the patient must be done to check for vital parameters, pallor, icterus, and features suggestive of fluid overload, raised jugular venous pressure, generalized lymphadenopathy, metastasis, body mass index and any tenderness in the spine. Appropriate work-up must be done to rule out distant metastasis in the most common sited such as lungs, lymph nodes, spine, brain and liver.

Routine preanesthetic assessment clinic (PAC) tests such as a complete blood workup, ECG, echocardiography, chest radiography, liver & renal function tests and serum electrolytes must be done for all patients. Patient should also be advised for smoking cessation as a high number of patients with head and neck cancer (HNC) have smoking history.

Patients should also be evaluated for any pre/concurrent radio - chemotherapy. Preoperative radiotherapy, this can give rise to difficult laryngoscopy, difficult intubation (**Figure 2**).
