Contemporary approach to the difficult airway

A difficult airway can arise as a primary emergent or urgent one, or during an elective procedure, with unexpected and rapid deterioration in oxygenation. Both scenarios may be handled differently. However, open communication and planning between airway specialists involved are critical for a good outcome. Depending on the underlying causes of difficult airway situations, different approaches and management algorithms obtain. The Otolaryngologist-Head and Neck Surgeon (OHNS) should be familiar and comfortable with difficult airway situations, have an open dialogue with the rest of the airway team, and always plan for failure (as demonstrated by the Difficult Airway Society algorithm sequence, Plan A-B-C-D). This discussion describes specific techniques for securing difficult airways commonly implemented by the OHNS.