Nasotracheal intubation: the preferred airway in oral cavity microvascular reconstructive surgery?

Publication date: Available online 11 April 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jordan Gigliotti, Godwin Cheung, Omar Suhaym, Ramanakumar V. Agnihotram, Michel El-Hakim, Nicholas Makhoul
PurposeTo describe the safety and effectiveness of nasotracheal intubation (NTI) in a cohort of patients undergoing reconstruction of oral cavity defects with free tissue transfer (FTT).MethodsThe authors implemented a retrospective cohort study and enrolled a sample composed of consecutive patients undergoing FTT reconstruction of oral cavity, maxillary, or mandibular defects between 2013 and 2017. These patients were all subject to a newly developed Enhanced Recovery After Surgery (ERAS) protocol. The primary outcome measurement was hospital length of stay (LOS). Secondary outcome variables were the duration of mechanical ventilation, intensive care unit (ICU) LOS, need for gastrostomy, and airway-related complications directly associated with either NTI or tracheostomy. Descriptive statistics and a multivariate logistic regression analysis were completed.ResultsThe sample was composed of 141 patients that had undergone oral cavity FTT for both benign and malignant diseases (NTI, n=111; tracheostomy, n=30). Patients managed with NTI had a statistically significant shorter hospital LOS (8 vs.15.5 days; P<0.0001), ICU LOS (1 vs. 2 days; P=0.0006), and a decreased requirement for gastrostomy (17.1 vs. 76.7%; P<0.0001). Airway-related complications were rare in both the tracheostomy (13.3%) and NTI (3.6%) groups. Multivariate analysis demonstrated that patients undergoing tracheostomy were 3.14 (P=0.004) times more likely to have a prolonged hospitalization and 10.4 (P<0.0001) times more likely to require a gastrostomy. A sensitivity analysis of patients' with malignant diagnoses only had similar statistically significant results. The delayed tracheostomy rate in the NTI group was 3.6%.ConclusionTo date, this is the largest study to evaluate the use of NTI in patients undergoing oral cavity reconstruction with FTT. Our results suggest, that in the appropriate institutional setting, the majority of patients can be safely managed with NTI. This approach results in a decreased hospital and ICU LOS and an earlier resumption of oral intake with less need for gastrostomy.



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