Airway ultrasound in patients undergoing head and neck surgery

Head and neck surgery poses unique challenges regarding airway management because conventional bedside predictors may be unreliable when anatomy is distorted, while rescue front-of-neck access may itself be compromised. This review examines point-of-care ultrasound applied to the airway as an adjunct for difficult airway risk stratification, front-of-neck access planning, airway device management, and perioperative airway assessment. The focus is on its contribution to airway management planning rather than standalone prediction.

Recent evidence most strongly supports airway ultrasound for cricothyroid membrane identification, particularly when surface landmarks are unreliable. Evidence also supports potential roles in personalized difficult airway planning, selected tracheal device decisions, and postoperative airway assessment. Its greatest value appears to lie in integration within structured airway strategies, including rescue preparedness, preprocedural mapping for awake airway management, and dynamic postoperative airway surveillance.

Airway ultrasound is a promising adjunct in head and neck airway management, especially where anatomy is altered and rescue planning is critical. Its most defensible current role is to support anatomy-informed planning rather than replace established airway assessment. Wider implementation requires outcome-based evidence, focused training, and integration into structured difficult airway pathways.