Airway Management in Microvascular Reconstruction of the Head and Neck: Current Practice Patterns

Area of Science:

• Head and Neck Surgery
• Reconstructive Surgery
• Anesthesiology

Background:

• Airway management is critical in head and neck free tissue transfer (FTT) reconstruction.
• Current practice patterns lack standardization, leading to variability in perioperative care.

Purpose of the Study:

• To identify current airway management strategies employed during FTT reconstruction of head and neck defects.
• To explore factors influencing the decision to perform tracheotomy.

Main Methods:

• A 27-question survey was distributed to members of the American Head and Neck Society (AHNS).
• The survey assessed the correlation between surgeon and patient variables with tracheotomy likelihood and technique.

Main Results:

• 151 responses were analyzed, with 69.5% of surgeons performing tracheotomy in most or every FTT case.
• Tracheotomy was more likely for patients with poor pulmonary status, larger defects, and glossectomy/oropharyngeal reconstruction.
• Tracheotomy was less likely for maxillary/palatal defects, and surgeons with >10 years of experience were less likely to perform it for hemiglossectomy defects.

Conclusions:

• This study highlights diverse airway management practices in head and neck FTT reconstruction.
• No definitive consensus exists regarding perioperative airway management, necessitating further research and guideline development.