title: Airway management after maxillectomy: routine tracheostomy is unnecessary.
abstract: OBJECTIVE
  There is a paucity of data to guide the optimal management of the airway in patients after maxillectomy. The decision on whether a concomitant tracheostomy is needed is often dictated by the surgeon's training and experience. We reviewed our experience with maxillectomy to assess the need for tracheostomy in postoperative airway management.
  
  
  METHODS
  Retrospective analysis at a university hospital.
  
  
  METHODS
  We identified 121 patients who underwent 130 maxillectomies between October 1990 and September 2001. Twenty-four of these were total (all six walls removed), 45 were subtotal (two or more walls removed), and 61 were limited (only one wall removed). Reconstruction ranged from none to microvascular free flap, with split-thickness skin graft being the most common reconstructive option.
  
  
  RESULTS
  Only 10 tracheostomies (7.7%) were performed at the time of maxillectomy. These included four tracheostomies in patients who underwent bulky flap reconstruction, two tracheostomies in patients who underwent both flap reconstruction and mandibulectomy, one tracheostomy in a patient who underwent mandibulectomy, one tracheostomy in a patient with mucormycosis in anticipation of prolonged ventilatory support postoperatively, and two tracheostomies at the surgeons' discretion because of concern for upper airway edema. Among the 111 patients who underwent 120 maxillectomies without concomitant tracheostomy, 1 patient (0.9%), a 74 year-old man with oxygen-dependent chronic obstructive pulmonary disease, required repeat intubation on day 3 and again on day 10 after the surgery, because of respiratory failure; fiberoptic examination confirmed the absence of upper airway compromise.
  
  
  CONCLUSIONS
  The routine performance of tracheostomy in patients undergoing maxillectomy is unnecessary. Selective use of tracheostomy may be indicated in situations in which mandibulectomy or bulky flap reconstruction is performed or a concern for postoperative oropharyngeal airway obstruction because of edema or packing exists.
authors.affiliation: Department of Otolaryngology, Wayne State University, School of Medicine, Detroit, Michigan 48201, USA. hlin@med.wayne.edu
authors.forename: Ho-Sheng
authors.initials: HS
authors.lastname: Lin
authors.forename: David
authors.initials: D
authors.lastname: Wang
authors.forename: Willard E
authors.initials: WE
authors.lastname: Fee
authors.forename: Richard L
authors.initials: RL
authors.lastname: Goode
authors.forename: David J
authors.initials: DJ
authors.lastname: Terris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000175:diagnosis / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000601:surgery*; D008443:Maxillary Sinus / Q000601:surgery*; D008875:Middle Aged; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery*; D010254:Paranasal Sinus Diseases / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D014139:Tracheostomy; D019564:Unnecessary Procedures