Recurrent head and neck tumors in the setting of previous reconstructive surgery and radiation

Abstract

The approach to a difficult airway in patients presenting with recurrent head and neck tumors in the setting of previous surgery or radiation poses challenges to both anesthesiologists and otolaryngologists. Multidisciplinary planning with close communication is required for effective and safe care. It is critical to understand how each patient's prior surgery and radiation distorts the baseline airway anatomy and what complications may arise when deciding on the primary airway management and back-up plans. Preoperative imaging, flexible laryngoscopy, and airway ultrasound may be incorporated into the decision-making process in addition to the traditional airway exam. While awake airway management techniques will be very common in this patient population, anticipating potential problems, back-up planning, flexibility, and teamwork are essential for optimal patient outcomes. This article will review the common challenges encountered during airway management in this population.