The management of upper respiratory tract pathologies is characterised by shared access to the upper airways between the anesthetic and surgical teams. Numerous strategies have been developed to ensure effective oxygenation and/or ventilation, but these must constantly be adapted to changing surgical imperatives. Access to restricted space and adequate exposure of anatomical structures remain key to efficient management. In recent years, a number of specialised centres have developed spontaneous ventilation techniques, which offer a promising alternative to conventional ventilation, but require fine control of sedation and good communication with the operators to identify suitable cases and control any associated risks.