Functional airway phenotyping: a new paradigm for perioperative airway assessment

Despite advances in airway assessment, the ability to predict perioperative airway-related complications remains limited. Current evaluation relies predominantly on static anatomical descriptors, although airway behavior results from the interaction of structural, physiological, biomechanical, and patient-specific determinants. We propose functional airway phenotyping (FAP) as a conceptual framework to integrate these complementary domains. FAP extends conventional anatomy-based airway assessment by linking airway structure with function through the integration of anatomical characteristics, physiological behavior, tissue mechanical properties, and patient-specific factors. Rather than representing a new bedside test or a validated classification system, FAP provides a structure–function framework to better understand why patients with similar anatomical characteristics may experience different airway-related outcomes. We discuss how multimodal assessment, including clinical history, imaging, dynamic airway evaluation, physiological surrogates, and emerging artificial intelligence–supported approaches, could support future individualized perioperative airway assessment. FAP provides a conceptual roadmap for integrating structure and function in perioperative airway assessment. Future studies should validate clinically meaningful Functional Airway Phenotyping and determine their role in precision perioperative airway management.