Objective: To study the prevalence and predictive factors of difficult postoperative airway management (DPAM) in patients with severe deep neck infection. Methods: This retrospective analytical study reviewed 76 patients with severe deep neck infection (severe DNI) who underwent surgical drainage at Phrachomklao Hospital between January 1, 2019, and November 30, 2025. Difficult postoperative airway management (DPAM) was defined as patients who required endotracheal intubation for more than 48 hours or needed for tracheostomy following surgery. Data were analyzed using descriptive statistics and logistic regression analysis. Results: Among all 76 patients, 41 patients (53.9%) had DPAM. Multivariate logistic regression analysis predictive factors of DPAM remained statistically significant for these factors: increasing age (adjusted OR = 1.03; 95% CI 1.01–1.06; p < .01), limited mouth opening (adjusted OR = 4.58; 95% CI 1.42–14.78; p = .01), and parapharyngeal abscess (adjusted OR = 5.02; 95% CI 1.18–21.29; p = .02). Conclusion: The prevalence of difficult postoperative airway management was 53.9% among patients with severe deep neck infection. The independent predictive factors were increasing age, limited mouth opening before surgery, and presence of a parapharyngeal abscess. Preoperative assessment of mouth opening, evaluation of abscess extension on imaging particularly in the parapharyngeal space, and systematic planning of airway management are essential steps to reduce the risk of postoperative airway complications in these patients.