Background
Tracheostomy is traditionally used for airway management in Head and Neck Oncological Surgery. This has associated morbidity and delayed post operative recovery. The development of Enhanced Recovery After Surgery (ERAS) protocols encourages consideration of whether tracheostomy is an absolute requirement for all patients in this cohort. This study assesses the safety of selective use of tracheostomy in this group.
Method
The Maxillofacial Head and Neck Oncology database was accessed, reviewing patterns of tracheostomy use in 141 consecutive patients between August 2021-September 2023. Variables recorded: patient demographics, histopathology, site, TNM staging, medical history, smoking and alcohol consumption status, resection, neck dissection status (unilateral, bilateral, none), reconstruction, placement of planned or emergency tracheostomy, days with tracheostomy, ICU stay, total hospital stay.
Results
One hundred forty-one patients (84 male, 58 female) had Maxillofacial Oncology procedures between August 2021-September 2023. Mean age was 62.3 (19.9 – 89.21). Squamous Cell Carcinoma (SCC) was the most common histopathological subtype (85.8%). Forty-two (29.7%) patients had no neck dissection; 73 (51.7%) a unilateral neck dissection; 26 (18.4%) bilateral neck dissection. Sixty (56%) patients had free flap reconstruction. Thirty-nine (27.6%) patients had tracheostomies. Two were unplanned tracheostomies. Only 31 of 60 patients who had a free flap had a tracheostomy.
Conclusions
The routine use of tracheostomy for airway management in patients undergoing surgical management of Oral Cavity malignancy is not required. This includes patients requiring free flap reconstruction. Appropriate patient selection is required. Avoidance of tracheostomy in this cohort reduces morbidity and decreases both ICU and total hospital stay.
JO Kearns, C Bowe, C Murphy C, JE O’Connell
National Oral and Maxillofacial Unit, St. James’s Hospital, Dublin