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. 2025 Jun;45(3):173-181.
doi: 10.14639/0392-100X-A711.

Airway assessment and management in head and neck cancer surgery

Chiara Mossinelli  1 , Giacomo Pietrobon  1 , Stefano Zorzi  1 , Marta Tagliabue  1   2 , Francesco Chu  1 , Emilia Tomarchio  3   4 , Daniele Sances  4 , Marco Venturino  4 , Mohssen Ansarin  1
Affiliations

Airway assessment and management in head and neck cancer surgery

Chiara Mossinelli et al. Acta Otorhinolaryngol Ital. 2025 Jun.

Abstract

Objectives: Head and neck cancer surgery (HNCS) is burdened by a great risk of difficult airway and adverse events during anaesthesia. This study describes our experience and provides a flowchart for airway management in HNCS.

Methods: We retrospectively reviewed 910 surgically treated patients (January 2022- January 2023, European Institute of Oncology, Milan, Italy). We selected malignant tumours of the upper airway and surgery performed under general anaesthesia. We report a descriptive analysis of the sample. The data collected were representative of our daily clinical practice and have been used to draw up a proposal for airway management in HNCS.

Results: 200 consecutive patients (males 71.5%, females 28.5%), median age 67 years, were selected. The most represented sites were larynx (44.5%), oral cavity (30.5%), and oropharynx (20%). Airway management was obtained by orotracheal intubation (61%), nasotracheal intubation (15%), awake intubation under fibreoptic endoscopic control (15%), and tracheostomy under local anaesthesia (9%). In 3 cases we performed tracheostomy in an emergency setting (all patients affected by laryngeal cancer in a locally advanced stage).

Conclusions: Airway management in HNCS represents a topic of compelling interest that requires careful planning, well-defined options of strategies, and close communication between anaesthesiologists and surgeons.

Keywords: difficult airway; head and neck cancer; intubation; tracheostomy; upper airway.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Cover figure.
Cover figure.
Challenging airway management in laryngeal cancer (*). Preoperative fibro-endoscopy of locally advanced laryngeal squamous cell carcinoma: supraglottic (A) and glottic site (B). Typical subglottic stenosis of a cricoid chondrosarcoma, visible in axial CT scan with contrast enhancement (C) and fiberoptic evaluation (D).
Figure 1.
Figure 1.
Flowchart of airway management for laryngeal tumour (A), oral cavity tumour (B), oropharyngeal tumour (C), parapharyngeal tumour (D), and nasal/paranasal sinus tumour (E).
Figure 2.
Figure 2.
Example of tongue-base ulcerated carcinoma. B: base of tongue; V: vallecula; E: epiglottis; *: ulcerated carcinoma.
Figure 3.
Figure 3.
Example of voluminous parapharyngeal mass (*): carcinoma ex pleomorphic adenoma with evident obstruction of the respiratory space. A) clinical transoral evaluation; B) axial magnetic resonance imaging T1 sequence with contrast enhancement.
See this image and copyright information in PMC

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