Long-lasting and extended maxillofacial surgery with operating times of more than ten hours are now routinely performed with an acceptable risk for the patient. Careful preoperative evaluation of the patient and interdisciplinary planning are essential for successful surgery. The close proximity of the surgical field and the airways as well as a high incidence of difficult intubation in these patients require special attention from the anaesthesiologist. Other perioperative focuses of anaesthesiological concern in long-lasting maxillofacial surgery are positioning of the patient, intra- and postoperative airway management, intraoperative monitoring, thermoregulation, fluid replacement and transfusion therapy.