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

Oral cancer surgery carries a high risk of upper airway obstruction; yet optimal airway management approach remains controversial.

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.

The study cohort included 75 patients with oral cancer, who underwent major intraoral resections and reconstruction with vascularized flaps.

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.

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.