Timing of tracheostomy in major head and neck surgery: preoperative or intraoperative?

To provide a comprehensive review of the current literature on perioperative tracheostomy in head and neck oncologic surgery. The review is timely due to a significant paradigm shift from routine to selective tracheostomy, the emergence of new technologies, and a deeper understanding of the procedure's prognostic and oncologic implications.

Recent literature challenges the routine use of tracheostomy in oral cancer patients, promoting selective use guided by validated scoring systems to reduce morbidity. The prognostic significance of preoperative tracheostomy, particularly in salvage laryngeal surgery, is now well-established as a marker for aggressive disease.

The management of tracheostomy in head and neck oncology requires a personalized, evidence-based approach. Key recommendations include prioritizing elective over emergent procedures, mastering the awake technique for compromised airways, using scoring systems to guide selective tracheostomy in oral cancers, and adhering to strict oncologic principles to prevent tumor seeding.