From 1979 to 1984, a pectoralis major musculocutaneous flap was used in 35 patients in order to cover a maxillofacial defect following either a gunshot wound or tissue loss after cancer surgery. In 50% of the cases, one or several operations were needed. 30% of the patients showed a fixed posture of the head preventing tracheal intubation by direct laryngoscopy. The measurement of the maxillopharyngeal angle helps to predict this impossibility. In such these cases intubation by fibroscopy was done to avoid tracheotomy.