The Mouth–Airway Connection: Anesthetic and Airway Considerations in Patients Undergoing Oral and Maxillofacial Procedures

¹Assistant Professor, Department of Periodontics, College of Dental Science (CODS), Amargadh, Bhavnagar, Gujarat, India
²Oral and Maxillofacial Surgeon, Karnataka, India
³Consultant Oral & Maxillofacial Surgeon and Founder, Adarsh’s Max Fax Care, Mysuru, Karnataka, India
⁴Professor, Department of Public Health Dentistry, College of Dental Sciences, Davangere, Karnataka, India
⁵Consultant Endodontist, Mysuru, Karnataka, India
⁶Senior Lecturer, HKE Society’s S. Nijalingappa Institute of Dental Sciences and Research, Kalaburagi, Karnataka, India

*Corresponding Author: Dr Vinayaka A M, BDS, MDS, DNHE, FAGE, ( PhD), ICOI, Department of Periodontics, College of Dental Science, K.J. Mehta TB Hospital Campus, Jithri, Amargadh, Tal. Sihor, Bhavnagar–364210, Gujarat, India, Phone: 91 9632407742, Email: [email protected]

Received Date: August 27, 2026

Published Date: September 22, 2026

Citation: Vinayaka AM, et al. (2026). The Mouth–Airway Connection: Anesthetic and Airway Considerations in Patients Undergoing Oral and Maxillofacial Procedures. Mathews J Anesth. 6(1):19.

Copyrights: Vinayaka AM. © (2026).

ABSTRACT

Oral and maxillofacial procedures present distinctive anesthetic challenges because the operative field and upper airway are anatomically contiguous. Surgical manipulation, bleeding, secretions, edema, distorted anatomy, instrumentation, and postoperative fixation may compromise airway patency. Safe management therefore requires preoperative assessment, anticipation of difficult ventilation or intubation, selection of a technique compatible with surgical access, continuous monitoring, and planned extubation.

Orotracheal and nasotracheal intubation remain important techniques, while supraglottic devices may be suitable in selected procedures. Submental intubation can provide an alternative when oral and nasal tubes interfere with surgical access and tracheostomy is undesirable. Procedural sedation adds risk because airway tone may decrease while the mouth is occupied by instruments; capnography may facilitate earlier detection of apnea and hypoventilation. Patients with obstructive sleep apnea, maxillofacial trauma, craniofacial abnormalities, head and neck tumors, or restricted mouth opening require particular attention.

This narrative review examines preoperative airway assessment, difficult-airway management, airway-device selection, nasotracheal and submental intubation, procedural sedation, intraoperative airway protection, extubation, postoperative monitoring, and multidisciplinary airway planning in oral and maxillofacial surgery.

Keywords: Airway Management; Anesthesia, Maxillofacial Surgery, Difficult Airway, Nasotracheal Intubation, Submental Intubation

ABBREVIATIONS

ASA: American Society of Anesthesiologists
OSA: Obstructive Sleep Apnea