title: Airway management in head and neck cancer patients undergoing microvascular free tissue transfer: delayed extubation as an alternative to routine tracheotomy.
abstract: OBJECTIVE
  The aim of this study was to evaluate two practices of airway management in patients undergoing head and neck cancer (HNC) resection and microvascular free tissue transfer (MFTT), and to assess the advantages and disadvantages of the two approaches.
  
  
  METHODS
  Patients undergoing a delayed extubation approach (NO-TRACH group) and patients undergoing primary tracheotomy (PRIM-TRACH group) were retrospectively evaluated in terms of perioperative and postoperative outcome measures.
  
  
  RESULTS
  Not performing routine tracheotomy was safe and no perioperative airway complications occurred. NO-TRACH patients were extubated after 1.1 ± 0.9 days (mean ± standard deviation) and secondary tracheotomy was necessary in three patients (13%). NO-TRACH patients revealed decreased duration of surgery (p <0.05) and showed trends to earlier resumption of oral feeding and decreased length of hospitalisation. Flap complication rates were similar in both groups, with an overall flap survival rate of 97.5% (n = 39/40).
  
  
  CONCLUSIONS
  With appropriate postoperative care, carefully selected patients undergoing major HNC resections with MFTT can be safely managed without routine tracheotomy.
authors.affiliation: , SWITZERLAND; christian.meerwein@usz.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Meerwein
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Pézier
authors.forename: Beatrice
authors.initials: B
authors.lastname: Beck-Schimmer
authors.forename: Stephan
authors.initials: S
authors.lastname: Schmid
authors.forename: Gerhard F
authors.initials: GF
authors.lastname: Huber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation; D002277:Carcinoma / Q000601:surgery*; D018572:Disease-Free Survival; D004750:Enteral Nutrition; D005260:Female; D005502:Food; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D033182:Intention; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D055806:Microvessels / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D061646:Operative Time; D009959:Oropharyngeal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply; D015996:Survival Rate; D013997:Time Factors; D014140:Tracheotomy