Indications for Elective Tracheostomy in Reconstructive Surgery in Patients With Oral Cancer.

Background: Oral cancer surgery carries a high risk of upper airway obstruction; yet optimal airway management approach remains controversial. Aim of Study: The purpose of the present study was to evaluate the use of tracheostomy in oncological patients undergoing oral cancer surgery with intra oral flap reconstruction. Methods: The study cohort included 75 patients with oral cancer, who underwent major intraoral resections and reconstruction with vascularized flaps. Results: Thirty-six percent of the patients received elective tracheostomy (27 patients). Mean hospital stay of the patients with tracheostomy was 28.4 +/- 12.5 days compared with 9.7 +/- 2.1 days in the nontracheostomy patients. A scoring system rendered from this study suggests that patients with a total scoring at or above 8 should be considered for elective tracheostomy. Conclusions: With appropriate postoperative monitoring, selected patients can be managed without routine elective tracheostomy, yet, patients with comorbidities, mostly elderly patients, which undergo surgical resection and reconstruction in high-risk areas that can result in a bulky flap that pose danger to the postoperative airway, should receive elective tracheostomy. (C) 2016 by Mutaz B. Habal, MD.

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