**Abstract**

Recognizing airway trauma and safety management is challenging for any anaesthesiologist. Many types of airway injuries require identifying airway anatomy correctly; early assessment and proper management are crucial for saving many lives. Proper management involves the classification of those patients into three categories. Each one has a unique and different control. Knowing your capabilities and skills are very important for safe airway management. It does not matter where you are but skills, knowledge of airway management algorithms and tools you have. After reading this book chapter, the participant will be able to define airway trauma, proper airway risk assessment and safety management.

**Keywords:** airway obstruction, facial injuries, intubation, mandibular fractures, maxillary fractures, maxillofacial injuries, surgical airway

#### **1. Introduction**

Many head and neck procedures have special and challenging requirements for anaesthesia care beyond airway management; however, securing the airway in patients with maxillofacial and neck trauma is crucial and lifesaving. Direct traumatic airway injury is rare (incidence <1%); hence, the airway assessment and management are not well structured because physicians rarely treat such cases [1, 2].

Trauma to the airway carries a life threatening situation because it can cause by itself airway obstruction or obstruction by blood, secretions, tissue oedema, debris and vomitus. It may be associated with cervical spine injury which will worsen intubating conditions. Finally, the risk of airway obstruction continues to postoperative period and the decision to extubate in part is based on the prevention of reintubation and/or to prevent postoperative airway obstruction by tissue oedema in certain types of trauma and facial bone fixation.

There are specific situations in patients with facial and neck trauma, as described by Hutchison et al. [3] to adversely affect the airway:

