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

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.

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.

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.