A comprehensive airway evaluation for head and neck surgery: from prediction to strategy.

Abstract

Purpose of review: This review discusses airway management in head and neck surgery, highlighting the shift from prediction-based assessment to strategy-based planning and risk stratification, and offers a model for comprehensive evaluation and management in this complex patient population.

Recent findings: Traditionally, the literature has focused on risk stratification rather than binary prediction of complexity, encompassing anatomical, disease-specific, functional and radiological parameters. Recent advances include context-sensitive planning, algorithm-driven airway checklists to identify complexity, team-directed approaches, and cognitive aids designed to facilitate rapid access to primary and alternative plans. New technologies such as dual endoscopy and high-flow nasal oxygen have expanded the clinician's toolkit, offering tailored methods to treat different challenges both patient (obstructed/bleeding airways) and surgery related (laser procedures/shared 'field of action'), thereby improving safety. Postoperative airway management and extubation planning have also been reinforced to reduce complications.

Summary: Safe airway management during head and neck surgery requires careful preoperative evaluation, a tailored approach, and effective interdisciplinary collaboration. The integration of new technologies and evidence-based strategies has contributed to improving both safety and outcomes.