Airway Management in Head and Neck Reconstruction

Airway management in head and neck reconstruction is not only an anesthesiology problem. Tumor location, previous surgery or radiotherapy, altered anatomy, postoperative edema, secretions, and the reconstruction itself can transform a routine airway into a major perioperative challenge.

Oleksii Lopushanskyi reviews how the surgical and anesthesia teams can anticipate these problems before entering the operating room. The lecture moves from standard oral and nasal intubation to endoscopic techniques and surgical airways, with particular attention to when a planned tracheostomy may be safer than dealing with an emergency one later.

The discussion covers LEMON and Mallampati assessment, the role of CT in identifying stenosis or tracheal displacement, airway considerations around tumors, tracheostomy tube types and sizing, extra-length tubes, postoperative care and decannulation. A particularly useful section focuses on the often-overlooked difficult extubation: when is it safe to remove the tube, and how realistic is reintubation after major reconstruction has changed the anatomy?

The closing Q&A adds practical details from head and neck oncology practice, including tracheostomy fixation, wound management, and situations where standard airway assumptions no longer apply.