Airway management following head and neck microvascular reconstruction: is tracheostomy mandatory?

xlomafota13 shared this article with you from Inoreader Airway management following head and neck microvascular reconstruction: is tracheostomy mandatory? Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Oct 13:S1808-8694(21)00152-X. doi: 10.1016/j.bjorl.2021.07.007. Online ahead of print. ABSTRACT OBJECTIVES: Airway management following maxillofacial microvascular reconstruction is a fundamental part of the perioperative management. In oral cavity microvascular reconstruction, the airway is potentially compromised by airway edema, flap edema or bulkiness, hematoma formation, or upper airway sequelae from surgery. Classical teaching advocates elective tracheostomy in patients undergoing maxillofacial free flap reconstruction, while others keep patients intubated overnight (delayed extubation). The optimal method for perioperative airway management is still debated. This study aim was to evaluate the morbidity associated with elective tracheostomy in patients undergoing maxillofacial microvascular reconstruction and to recognize those patients who can avoid elective tracheostomy. METHODS: Retrospectiv e review of patients who underwent maxillofacial microvascular free flap reconstruction, between November 1st 2010 and October 31st 2019 in our center. RESULTS: One-hundred and nine patients underwent microvascular reconstruction in the maxillofacial region. Sixty-one patients underwent an elective tracheostomy upon the primary surgery. Forty-eight patients were left intubated overnight. Seven patients underwent a late tracheostomy which was performed upon a neck re-exploration for postoperative complications, except for one patient which was due to failed extubation attempt. Patients who didn't receive an elective tracheostomy were younger and had a shorter duration of postoperative hospitalization. Seven patients suffered from tracheostomy- related complications, all of them underwent elective tracheostomy and none were from the late tracheostomy group. CONCLUSIONS: Our results suggest, the routine use of elective tracheostomy in maxillofacial mic rovascular free flap reconstruction is unnecessary. Elective tracheostomy should be considered on case-to-case basis. LEVEL OF EVIDENCE: 4. PMID:34756557 | DOI:10.1016/j.bjorl.2021.07.007 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.