Prognostic factors for tracheostomy in patients with cervicofacial cellulitis

Upper airway management is challenging in patients with cervico-facial cellulitis. Our objectives were to determine the prevalence of non-opening of a trismus after induction, as well as to compare the radiological and biological factors associated with tracheostomy.

We conducted a prospective, single-center cohort study including consecutively all patients with cervicofacial cellulitis with an indication for surgical drainage under general anesthesia, between October 2021 and March 2022, and a retrospective cohort of patients who required a tracheostomy during the management of cervicofacial cellulitis, between January 2019 and September 2021. We first compared mouth opening measurements before and after anesthetic induction in the prospective cohort. We then used logistic regressions to determine clinic-radiological factors associated with tracheostomy.

The prospective cohort included 55 patients. All patients for whom measurements were taken (17/17) had an increase in mouth opening after induction. In multivariate analyses, dysphagia, and a non-homogeneous collection were significantly associated with tracheostomy.

We found that trismus was reversible in all patients for whom measurements were taken after induction. We therefore consider that trismus should not be a criterion for difficult intubation in cases of cervico-facial cellulitis. We then found clinico-radiological factors associated with an increased risk of tracheostomy.