Tracheotomy in patients receiving maxillectomy free flap reconstruction

Objective: To evaluate the effect airway management on perioperative outcomes of patients undergoing maxillectomy free flap reconstruction. Background: Sinonasal cancers represent 3% of upper aerodigestive malignancies. Combined modality treatment including surgical resection is common. Maxillectomy defects require complex three dimensional reconstructions often best suited by microvascular free tissue transfer. Operative airway management during this procedure has sparse discussion in the literature and is often dictated by surgical dogma. Methods: A retrospective review of patients receiving maxillectomy with microvascular reconstruction between 1999 and 2010. Patient's airways were managed with or without elective tracheotomy. The primary outcome was incidence of airway complication including pneumonia and need for advanced airway intervention. Results: 55 of 100 patients received elective tracheotomy perioperatively. The incidence of airway complication was equivalent between groups. The mean total hospital stay was prolonged in the tracheotomy group. Patients with cardiopulmonary comorbidities were more likely to receive perioperative tracheotomy without a difference in airway complications. Conclusions: Elective tracheotomy may safely be avoided in a subset of patients undergoing maxillectomy with microvascular reconstruction. Elective tracheotomy should be considered in patients with cardiopulmonary risk factors and is associated with increased length of hospital stay.