Anesthesia for head and neck trauma should be approached utilizing the basic principles of advanced trauma life support (ATLS). The general principles for the anesthetic management of other trauma surgery must be applied to ENT trauma operations. The anesthesiologist must act as the primary resuscitator and principal manager of the airway. In the primary survey, the ABCDE sequence of trauma should be performed: airway, breathing, circulation, disability and neurologic status, and exposure and overall evaluation for other injuries. In children, oxygenation and ventilation are best accomplished by a needle cricothyroidotomy. A needle cricothyroidotomy may be used to temporize the patient until a more formal surgical airway is established. Airway management is best performed with knowledge of airway anatomy, an understanding of the impact of the trauma on the airway, and a thoughtful approach to the deployment of different airway devices.