Difficult Airway Management in Oromaxillofacial Tumor Surgery: Two Case Reports and Review of the Literature

Difficult airway management in oromaxillofacial tumor surgery poses significant challenges for anesthesiologists. We present two case reports of patients with mandibular malignant tumors and maxillary osteosarcoma who underwent surgery under general anesthesia. Preoperative assessment revealed a mass involving the right mandible, completely covering the inside of the mouth and invading the floor of the mouth in the first case, and a mass in the left maxilla extending to the zygomatic arch and orbital floor in the second case. Both patients had limited mouth opening, making direct laryngoscopy impossible. Awake fiberoptic intubation was planned to secure the airway while preserving spontaneous breathing. Sedation was achieved using dexmedetomidine, propofol, and ketamine. The fiberoptic bronchoscope was inserted through the nasal cavity, and the endotracheal tube was advanced once the vocal cords were visualized. Muscle relaxation was induced with rocuronium after confirmation of tracheal placement. Both patients underwent extensive surgical resection and reconstruction procedures. Postoperatively, they were managed in the intensive care unit and subsequently transferred to the ENT service after successful weaning from mechanical ventilation.These cases highlight the importance of thorough preoperative assessment, multidisciplinary planning, and the use of advanced airway management techniques such as awake fiberoptic intubation in patients with oromaxillofacial tumors presenting with anticipated difficult airways.