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Patients undergoing oromaxillofacial and head and neck surgery can have pathologies that threaten the reliability of oxygen delivery under anaesthesia. Airway management requires a patient-specific and procedure-specific focus, working within the skillset of the anaesthesia and surgical services of the day. This chapter on difficult airway management focuses upon airway assessment and the formation of an airway management plan. Core airway management techniques are discussed, including bag mask ventilation, use of supraglottic airway devices, and laryngoscopy by direct and video-based means. The importance of positioning, preoxygenation, and neuromuscular blockade is explained. Awake airway management techniques (awake fibreoptic intubation, awake videolaryngoscopy, and awake tracheostomy) are discussed, being viewed as essential components of anaesthetists’ armamentarium. Airway management for maxillomandibular fixation is afforded special attention due to the requirement for specific knowledge and skills. The extubation process is explored, with pre-emptive and rescue techniques that may reduce the likelihood of airway compromise during this period identified. Finally, the contribution of human factors to difficult airway management is considered, with task fixation and cognitive overload highlighted as potential threats that must be overcome by anaesthetists in order to prioritize reliable patient oxygenation.

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