Utility of Video Laryngoscopes in Head and Neck Cancer Surgeries Performed in Adult Patients – A Systematic Review

Vollständiger Abstract

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Abstract Airway management in adult head and neck cancer surgeries is often compromised by tumour distortion, trismus and radiation fibrosis. While awake flexible bronchoscopy remains the gold standard, video laryngoscopy (VL) increasingly serves as a first-line modality under general anaesthesia. This systematic review evaluates the utility, efficacy and safety of VL compared to direct laryngoscopy (DL) during nasotracheal intubation (NTI) in adult head and neck oncology surgeries. A systematic literature search (2014–2025) was performed to include original research articles on adult head and neck cancer surgeries requiring single-lumen NTI. Case reports, simulations and orotracheal intubations were excluded. Risk of bias (RoB) was appraised via Cochrane RoB 2 and the Methodological Index for Non-Randomized Studies tools. Data were evaluated via a qualitative narrative synthesis. This review was prospectively registered under the International Prospective Register of Systematic Reviews: CRD420261400576. Four original studies comprising 317 adult patients using VL were included. The synthesis favours VL over DL. VL provided superior glottis visualisation (Cormack–Lehane Grade I/II) and a first-pass success rate of 87% to 100%. VL decreased total intubation duration, minimised airway trauma and reduced the reliance on supplementary manoeuvres. VL is an efficient first-line tool under general anaesthesia that optimises NTI success and safety in select head and neck oncology surgeries. However, because blade insertion requires a minimum mouth opening of 1.5 cm, it cannot completely replace awake flexible bronchoscopy in cases with severe anatomical airway restriction.