Clinical outcome of perioperative airway and ventilatory management in patients undergoing surgery for oral cavity cancer: a prospective observational study.
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Abstract
Objectives: This prospective observational study aimed to assess the clinical outcomes of perioperative airway and ventilatory management in patients undergoing surgery for oral cavity cancer. The study described the frequencies and types of procedures for securing the airway and the duration and types of postoperative ventilatory support. We compared the findings with those of the TRACHY study.
Patients and methods: One hundred patients undergoing oral cavity oncological surgeries were included. Airway assessment included inter-incisor gap, Mallampati class, neck movements, and radiological features. Surgical parameters, postoperative ventilatory support, and complications were documented.
Results: The buccal mucosa was the most common cancer site (48.0%), and direct laryngoscopy was deemed difficult in 58.0% of patients. Awake fibreoptic intubation or elective tracheostomy was required in 43.0% of cases. Thirty-three patients were extubated on the table, and 34 patients were successfully managed with a delayed extubation strategy. In comparison with the TRACHY study, variations were observed in demographic parameters, tumour characteristics, and surgical interventions. Our mean TRACHY score was 1.38, and only five patients had a score ≥4. Prophylactic tracheostomy was performed in 2.0% of cases, in contrast to the TRACHY study in which 42.0% of patients underwent the procedure.
Conclusion: The study emphasizes the challenges in airway management for oral cavity cancer surgery. While prophylactic tracheostomy may be necessary in specific cases, individualized approaches, including delayed extubation, are preferrable to maximize safety. Our findings contribute to better understanding and managing perioperative challenges in oral cancer patients and highlight the need for personalized strategies. Scoring systems like TRACHY should not be accepted as universally applicable.
期刊介绍：
Journal of the Korean Association of Oral and Maxillofacial Surgeons (J Korean Assoc Oral Maxillofac Surg) is the official journal of the Korean Association of Oral and Maxillofacial Surgeons. This bimonthly journal offers high-quality original articles, case series study, case reports, collective or current reviews, technical notes, brief communications or correspondences, and others related to regenerative medicine, dentoalveolar surgery, dental implant surgery, head and neck cancer, aesthetic facial surgery/orthognathic surgery, facial injuries, temporomandibular joint disorders, orofacial disease, and oral pathology. J Korean Assoc Oral Maxillofac Surg is of interest to oral and maxillofacial surgeons and dental practitioners as well as others who are interested in these fields.
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