Airway management after maxillectomy: Routine tracheostomy is unnecessary

Ho Sheng Lin, David Wang, Willard E. Fee, Richard L. Goode, David J Terris

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objectives/Hypothesis: There is a paucity of data to guide the optimal management of the airway in patients after maxillectomy. The decision on whether a concomitant tracheostomy is needed is often dictated by the surgeon's training and experience. We reviewed our experience with maxillectomy to assess the need for tracheostomy in postoperative airway management. Study Design: Retrospective analysis at a university hospital. Methods: We identified 121 patients who underwent 130 maxillectomies between October 1990 and September 2001. Twenty-four of these were total (all six walls removed), 45 were subtotal (two or more walls removed), and 61 were limited (only one wall removed). Reconstruction ranged from none to microvascular free flap, with split-thickness skin graft being the most common reconstructive option. Results: Only 10 tracheostomies (7.7%) were performed at the time of maxillectomy. These included four tracheostomies in patients who underwent bulky flap reconstruction, two tracheostomies in patients who underwent both flap reconstruction and mandibulectomy, one tracheostomy in a patient who underwent mandibulectomy, one tracheostomy in a patient with mucormycosis in anticipation of prolonged ventilatory support postoperatively, and two tracheostomies at the surgeons' discretion because of concern for upper airway edema. Among the 111 patients who underwent 120 maxillectomies without concomitant tracheostomy, 1 patient (0.9%), a 74 year-old man with oxygen-dependent chronic obstructive pulmonary disease, required repeat intubation on day 3 and again on day 10 after the surgery, because of respiratory failure; fiberoptic examination confirmed the absence of upper airway compromise. Conclusions: The routine performance of tracheostomy in patients undergoing maxillectomy is unnecessary. Selective use of tracheostomy may be indicated in situations in which mandibulectomy or bulky flap reconstruction is performed or a concern for postoperative oropharyngeal airway obstruction because of edema or packing exists.

Original languageEnglish (US)
Pages (from-to)929-932
Number of pages4
JournalLaryngoscope
Volume113
Issue number6
DOIs
StatePublished - Jun 1 2003

Fingerprint

Airway Management
Tracheostomy
Edema
Mucormycosis
Free Tissue Flaps
Airway Obstruction
Intubation
Respiratory Insufficiency
Chronic Obstructive Pulmonary Disease
Retrospective Studies
Oxygen
Transplants

Keywords

  • Airway complication
  • Airway management
  • Maxillectomy
  • Tracheostomy

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Airway management after maxillectomy : Routine tracheostomy is unnecessary. / Lin, Ho Sheng; Wang, David; Fee, Willard E.; Goode, Richard L.; Terris, David J.

In: Laryngoscope, Vol. 113, No. 6, 01.06.2003, p. 929-932.

Research output: Contribution to journalArticle

Lin, Ho Sheng ; Wang, David ; Fee, Willard E. ; Goode, Richard L. ; Terris, David J. / Airway management after maxillectomy : Routine tracheostomy is unnecessary. In: Laryngoscope. 2003 ; Vol. 113, No. 6. pp. 929-932.
@article{dce656a5e62542448e690d862dbf00b2,
title = "Airway management after maxillectomy: Routine tracheostomy is unnecessary",
abstract = "Objectives/Hypothesis: There is a paucity of data to guide the optimal management of the airway in patients after maxillectomy. The decision on whether a concomitant tracheostomy is needed is often dictated by the surgeon's training and experience. We reviewed our experience with maxillectomy to assess the need for tracheostomy in postoperative airway management. Study Design: Retrospective analysis at a university hospital. Methods: We identified 121 patients who underwent 130 maxillectomies between October 1990 and September 2001. Twenty-four of these were total (all six walls removed), 45 were subtotal (two or more walls removed), and 61 were limited (only one wall removed). Reconstruction ranged from none to microvascular free flap, with split-thickness skin graft being the most common reconstructive option. Results: Only 10 tracheostomies (7.7{\%}) were performed at the time of maxillectomy. These included four tracheostomies in patients who underwent bulky flap reconstruction, two tracheostomies in patients who underwent both flap reconstruction and mandibulectomy, one tracheostomy in a patient who underwent mandibulectomy, one tracheostomy in a patient with mucormycosis in anticipation of prolonged ventilatory support postoperatively, and two tracheostomies at the surgeons' discretion because of concern for upper airway edema. Among the 111 patients who underwent 120 maxillectomies without concomitant tracheostomy, 1 patient (0.9{\%}), a 74 year-old man with oxygen-dependent chronic obstructive pulmonary disease, required repeat intubation on day 3 and again on day 10 after the surgery, because of respiratory failure; fiberoptic examination confirmed the absence of upper airway compromise. Conclusions: The routine performance of tracheostomy in patients undergoing maxillectomy is unnecessary. Selective use of tracheostomy may be indicated in situations in which mandibulectomy or bulky flap reconstruction is performed or a concern for postoperative oropharyngeal airway obstruction because of edema or packing exists.",
keywords = "Airway complication, Airway management, Maxillectomy, Tracheostomy",
author = "Lin, {Ho Sheng} and David Wang and Fee, {Willard E.} and Goode, {Richard L.} and Terris, {David J}",
year = "2003",
month = "6",
day = "1",
doi = "10.1097/00005537-200306000-00002",
language = "English (US)",
volume = "113",
pages = "929--932",
journal = "Laryngoscope",
issn = "0023-852X",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Airway management after maxillectomy

T2 - Routine tracheostomy is unnecessary

AU - Lin, Ho Sheng

AU - Wang, David

AU - Fee, Willard E.

AU - Goode, Richard L.

AU - Terris, David J

PY - 2003/6/1

Y1 - 2003/6/1

N2 - Objectives/Hypothesis: There is a paucity of data to guide the optimal management of the airway in patients after maxillectomy. The decision on whether a concomitant tracheostomy is needed is often dictated by the surgeon's training and experience. We reviewed our experience with maxillectomy to assess the need for tracheostomy in postoperative airway management. Study Design: Retrospective analysis at a university hospital. Methods: We identified 121 patients who underwent 130 maxillectomies between October 1990 and September 2001. Twenty-four of these were total (all six walls removed), 45 were subtotal (two or more walls removed), and 61 were limited (only one wall removed). Reconstruction ranged from none to microvascular free flap, with split-thickness skin graft being the most common reconstructive option. Results: Only 10 tracheostomies (7.7%) were performed at the time of maxillectomy. These included four tracheostomies in patients who underwent bulky flap reconstruction, two tracheostomies in patients who underwent both flap reconstruction and mandibulectomy, one tracheostomy in a patient who underwent mandibulectomy, one tracheostomy in a patient with mucormycosis in anticipation of prolonged ventilatory support postoperatively, and two tracheostomies at the surgeons' discretion because of concern for upper airway edema. Among the 111 patients who underwent 120 maxillectomies without concomitant tracheostomy, 1 patient (0.9%), a 74 year-old man with oxygen-dependent chronic obstructive pulmonary disease, required repeat intubation on day 3 and again on day 10 after the surgery, because of respiratory failure; fiberoptic examination confirmed the absence of upper airway compromise. Conclusions: The routine performance of tracheostomy in patients undergoing maxillectomy is unnecessary. Selective use of tracheostomy may be indicated in situations in which mandibulectomy or bulky flap reconstruction is performed or a concern for postoperative oropharyngeal airway obstruction because of edema or packing exists.

AB - Objectives/Hypothesis: There is a paucity of data to guide the optimal management of the airway in patients after maxillectomy. The decision on whether a concomitant tracheostomy is needed is often dictated by the surgeon's training and experience. We reviewed our experience with maxillectomy to assess the need for tracheostomy in postoperative airway management. Study Design: Retrospective analysis at a university hospital. Methods: We identified 121 patients who underwent 130 maxillectomies between October 1990 and September 2001. Twenty-four of these were total (all six walls removed), 45 were subtotal (two or more walls removed), and 61 were limited (only one wall removed). Reconstruction ranged from none to microvascular free flap, with split-thickness skin graft being the most common reconstructive option. Results: Only 10 tracheostomies (7.7%) were performed at the time of maxillectomy. These included four tracheostomies in patients who underwent bulky flap reconstruction, two tracheostomies in patients who underwent both flap reconstruction and mandibulectomy, one tracheostomy in a patient who underwent mandibulectomy, one tracheostomy in a patient with mucormycosis in anticipation of prolonged ventilatory support postoperatively, and two tracheostomies at the surgeons' discretion because of concern for upper airway edema. Among the 111 patients who underwent 120 maxillectomies without concomitant tracheostomy, 1 patient (0.9%), a 74 year-old man with oxygen-dependent chronic obstructive pulmonary disease, required repeat intubation on day 3 and again on day 10 after the surgery, because of respiratory failure; fiberoptic examination confirmed the absence of upper airway compromise. Conclusions: The routine performance of tracheostomy in patients undergoing maxillectomy is unnecessary. Selective use of tracheostomy may be indicated in situations in which mandibulectomy or bulky flap reconstruction is performed or a concern for postoperative oropharyngeal airway obstruction because of edema or packing exists.

KW - Airway complication

KW - Airway management

KW - Maxillectomy

KW - Tracheostomy

UR - http://www.scopus.com/inward/record.url?scp=0038661057&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0038661057&partnerID=8YFLogxK

U2 - 10.1097/00005537-200306000-00002

DO - 10.1097/00005537-200306000-00002

M3 - Article

C2 - 12782798

AN - SCOPUS:0038661057

VL - 113

SP - 929

EP - 932

JO - Laryngoscope

JF - Laryngoscope

SN - 0023-852X

IS - 6

ER -