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July 1992

Is Nasotracheal Intubation Safe in Surgery for Mandibular Cancer?

Author Affiliations

From the Departments of Anesthesia (Dr Randell), Maxillofacial Surgery (Drs Söderholm and Lindqvist), Fourth Department of Surgery, Helsinki (Finland) University Central Hospital.

Arch Otolaryngol Head Neck Surg. 1992;118(7):725-728. doi:10.1001/archotol.1992.01880070055011

• A retrospective study of problems of postoperative airway maintenance after surgery for mandibular cancers was conducted. Twenty-seven patients treated in an intensive care unit after mandibular resection and primary reconstruction were included. The mean duration of nasotracheal intubation in 22 patients was 33.7 hours. Reintubation because of breathing difficulties was required in four cases. In one of these cases, failed intubation led to an emergency cricothyroidostomy. Failure to perform reintubation resulted in the death of one patient. One patient was tracheostomized after 5 days of nasotracheal intubation. Prolonged nasotracheal intubation after major surgery for oral malignant neoplasms may be an alternative to tracheostomy, provided that adequate monitoring is available after extubation. The safe duration of endotracheal intubation is difficult to determine. Primary reconstruction does not eliminate the need for an artificial airway after tumor surgery.

(Arch Otolaryngol Head Neck Surg. 1992;118:725-728)