Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 144 No. 0910 (2014)

Airway management in head and neck cancer patients undergoing microvascular free tissue transfer: delayed extubation as an alternative to routine tracheotomy

  • Christian Martin Meerwein
  • Thomas F Pézier
  • Beatrice Beck-Schimmer
  • Stephan Schmid
  • Gerhard Frank Huber
DOI
https://doi.org/10.4414/smw.2014.13941
Cite this as:
Swiss Med Wkly. 2014;144:w13941
Published
23.02.2014

Summary

QUESTIONS UNDER STUDY: The aim of this study was to evaluate two practices of airway management in patients undergoing head and neck cancer (HNC) resection and microvascular free tissue transfer (MFTT), and to assess the advantages and disadvantages of the two approaches.

METHODS:Patients undergoing a delayed extubation approach (NO-TRACH group) and patients undergoing primary tracheotomy (PRIM-TRACH group) were retrospectively evaluated in terms of perioperative and postoperative outcome measures.

RESULTS:Not performing routine tracheotomy was safe and no perioperative airway complications occurred. NO-TRACH patients were extubated after 1.1 ± 0.9 days (mean ± standard deviation) and secondary tracheotomy was necessary in three patients (13%). NO-TRACH patients revealed decreased duration of surgery (p <0.05) and showed trends to earlier resumption of oral feeding and decreased length of hospitalisation. Flap complication rates were similar in both groups, with an overall flap survival rate of 97.5% (n = 39/40).

CONCLUSIONS:With appropriate postoperative care, carefully selected patients undergoing major HNC resections with MFTT can be safely managed without routine tracheotomy.

References

  1. Lin HS, Wang D, Fee WE, Goode RL, Terris DJ. Airway management after maxillectomy: routine tracheostomy is unnecessary. Laryngoscope. 2003;113(6):929–32. Epub 2003/06/05. doi: 10.1097/00005537–200306000–00002. PubMed PMID: 12782798.
  2. Brickman DS, Reh DD, Schneider DS, Bush B, Rosenthal EL, Wax MK. Airway management after maxillectomy with free flap reconstruction. Head Neck. 2013;35(8):1061–5. doi: 10.1002/hed.23082. PubMed PMID: 22907774.
  3. Pohlenz P, Klatt J, Schmelzle R, Li L. The importance of in-hospital mortality for patients requiring free tissue transfer for head and neck oncology. Br J Oral Maxillofac Surg. 2013;51(6):508–13. doi: 10.1016/j.bjoms.2012.10.020. PubMed PMID: 23369783.
  4. Tarsitano A, Pizzigallo A, Sgarzani R, Oranges CM, Cipriani R, Marchetti C. Head and neck cancer in elderly patients: is microsurgical free-tissue transfer a safe procedure? Acta Otorhinolaryngol Ital. 2012;32(6):371–5. Epub 2013/01/26. PubMed PMID: 23349555; PubMed Central PMCID: PMC3552542.
  5. Classen DA, Ward H. Complications in a consecutive series of 250 free flap operations. Ann Plast Surg. 2006;56(5):557–61. Epub 2006/04/28. doi: 10.1097/01.sap.0000205830.39108.9a00000637–200605000–00018 [pii]. PubMed PMID: 16641636.
  6. Halfpenny W, McGurk M. Analysis of tracheostomy-associated morbidity after operations for head and neck cancer. Br J Oral Maxillofac Surg. 2000;38(5):509–12. Epub 2000/09/30. doi: 10.1054/bjom.2000.0310S0266–4356(00)90310–3 [pii]. PubMed PMID: 11010784.
  7. Fattahi T, Vega L, Fernandes R, Goldman N, Steinberg B, Schare H. Our experience with 171 open tracheostomies. J Oral Maxillofac Surg. 2012;70(7):1699–702. Epub 2011/10/25. doi: 10.1016/j.joms.2011.07.015S0278–2391(11)01261–4 [pii]. PubMed PMID: 22018448.
  8. Beausang ES, Ang EE, Lipa JE, Irish JC, Brown DH, Gullane PJ, et al. Microvascular free tissue transfer in elderly patients: the Toronto experience. Head Neck. 2003;25(7):549–53. doi: 10.1002/hed.10240. PubMed PMID: 12808658.
  9. Ong SK, Morton RP, Kolbe J, Whitlock RM, McIvor NP. Pulmonary complications following major head and neck surgery with tracheostomy: a prospective, randomized, controlled trial of prophylactic antibiotics. Arch Otolaryngol Head Neck Surg. 2004;130(9):1084–7. Epub 2004/09/24. doi: 10.1001/archotol.130.9.1084130/9/1084 [pii]. PubMed PMID: 15381595.
  10. Skoner JM, Andersen PE, Cohen JI, Holland JJ, Hansen E, Wax MK. Swallowing function and tracheotomy dependence after combined-modality treatment including free tissue transfer for advanced-stage oropharyngeal cancer. Laryngoscope. 2003;113(8):1294–8. Epub 2003/08/05. doi: 10.1097/00005537–200308000–00005. PubMed PMID: 12897548.
  11. Cameron M, Corner A, Diba A, Hankins M. Development of a tracheostomy scoring system to guide airway management after major head and neck surgery. Int J Oral Maxillofac Surg. 2009;38(8):846–9. Epub 2009/05/09. doi: 10.1016/j.ijom.2009.03.713S0901–5027(09)00821–2 [pii]. PubMed PMID: 19423295.
  12. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM: Springer; 2010. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20180029.
  13. Disa JJ, Pusic AL, Hidalgo DH, Cordeiro PG. Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection. Ann Plast Surg. 2001;47(4):385–9. Epub 2001/10/17. PubMed PMID: 11601572.
  14. Holom GH, Seland H, Strandenes E, Liavaag PG, Lybak S, Løes S, et al. Head and neck reconstruction using microsurgery: a 9–year retrospective study. Eur Arch Otorhinolaryngol. 2013;270(10):2737–43. doi: 10.1007/s00405–013–2390–7. PubMed PMID: 23417224.
  15. Dassonville O, Poissonnet G, Chamorey E, Vallicioni J, Demard F, Santini J, et al. Head and neck reconstruction with free flaps: a report on 213 cases. Eur Arch Otorhinolaryngol. 2008;265(1):85–95. Epub 2007/08/11. doi: 10.1007/s00405–007–0410–1. PubMed PMID: 17690895.
  16. Hidalgo DA, Disa JJ, Cordeiro PG, Hu QY. A review of 716 consecutive free flaps for oncologic surgical defects: refinement in donor-site selection and technique. Plast Reconstr Surg. 1998;102(3):722–32; discussion 33–4. Epub 1998/09/04. PubMed PMID: 9727437.
  17. Suh JD, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Alam D, et al. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 2004;130(8):962–6. Epub 2004/08/18. doi: 10.1001/archotol.130.8.962130/8/962 [pii]. PubMed PMID: 15313867.

Most read articles by the same author(s)