EFFICACY OF OVERNIGHT INTUBATION IN ORAL ONCOLOGICAL SURGERIES A RETROSPECTIVE STUDY

In the post-operative period of maxillofacial oncological operations, tracheostomy is the most commonly used method for securing the airway. These untoward complications made practitioners choose alternative modalities like submental intubation, but literature support on alternatives to tracheostomy for oral oncologic cases is limited. The aim of this observational study is to ascertain whether the use of overnight intubation is a safer and cost-effective practice and if it can be considered an alternative to tracheostomy.

Material and methods. 30 patients, 23 males and 7 females in the age group of 34–80 years who underwent treatment for head and neck cancer with major intraoral resection and a unilateral or bilateral neck dissection were included in the study. The following variables were recorded: age, sex, site of tumour, type of neck dissection, use of mandibulotomy/ mandibulectomy, type of reconstruction, duration of stay in ICU, mean hospital stay and Mallampati classification. Postoperative complications, associated with the airway, if any, were recorded simultaneously.

Results. None of the 30 patients required re-intubation nor did they develop any respiratory distress post extubation.

1. Crosher R., Baldie C., Mitchell R. Selective use of tracheostomy in surgery for head and neck cancer: an audit. Br J Oral Maxillofac Surg. 1997 Feb; 35 (1): 43–5.

2. Castling B., Telfer M., Avery B.S. Complications of tracheostomy in major head and neck cancer surgery; a retrospective study of 60 consecutive cases. Br J Oral Maxillofac Surg. 1994 Feb; 32 (1): 3–5.

3. Halfpenny W., McGurk M. Analysis of tracheostomy-associated morbidity after operations for head and neck cancer. Br J Oral Maxillofac Surg. 2000 Oct; 38 (5): 509–12.

4. Waldron J., Padgham N.D., Hurley S.E. Complications of emergency and elective tracheostomy: a retrospective study of 150 consecutive cases. Ann R Coll Surg Engl. 1990 Jul; 72 (4): 218–20.

5. Taicher S., Givol N., Peleg M., Ardekian L. Changing indications for tracheostomy in maxillofacial trauma. J Oral Maxillofac Surg. 1996 Mar; 54 (3): 292–5.

6. Morton R.P., Mellow C.G., Dorman E.B. Chest infection following head and neck surgery; a pilot study. Clin Otolaryngol Allied Sci. 1990 Aug; 15 (4): 363–6.

7. Rao M.K., Reilley T.E., Schuller D.E., Young D.C. Analysis of risk factors for postoperative pulmonary complications in head and neck surgery. Laryngoscope 1992; 102: 45–7. doi: 10.1288/00005537199201000-00008.

8. Ong S.K., Morton R.P., Kolbe J., Whitlock R.M., McIvor N.P. Pulmonary complications following major head and neck surgery with tracheostomy: A prospective, randomized, controlled trial of prophylactic antibiotics. Arch Otolaryngol Head Neck Surg 2004; 130: 1084–7. doi: 10.1001/archotol.130.9.1084.

9. Coyle M.J., Main B., Hughes C., Craven R., Alexander R., Porter G., Thomas S. Enhanced recovery after surgery (ERAS) for head and neck oncology patients. Clin Otolaryngol. 2016 Apr; 41 (2): 118–26. doi: 10.1111/coa.12482.

10. Scutz P., Hamed H. Submental intubation versus tracheostomy in maxillofacial trauma patients. J Oral Maxillofac Surg. 2008 Jul; 66 (7): 1404–9. doi: 10.1016/j.joms.2007.12.027.

11. Niederman M.S., Ferranti R.D., Zeigler A., Merrill W.W., Reynolds H.Y. Respiratory infection complicating long-term tracheostomy: the implication of persistent gram-negative tracheobronchial colonization. Chest. 1984 Jan 1; 85 (1): 39–44.

12. Coyle M.J., Shrimpton A., Perkins C., Fasanmade A., Godden D. First do no harm: should routine tracheostomy after oral and maxillofacial oncological operations be abandoned? Br J Oral Maxillofac Surg. 2012 Dec; 50 (8): 732–5. doi: 10.1016/j.bjoms.2012.01.003