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Original Investigation
January 2016

Factors in Successful Elimination of Elective Tracheotomy in Mandibular Reconstruction With Microvascular Tissue

Author Affiliations
  • 1New York University School of Medicine, New York
  • 2New York University School of Medicine, Department of Otolaryngology–Head & Neck Surgery, New York
  • 3Departments of Plastic Surgery and Neurosurgery, New York University, New York
JAMA Otolaryngol Head Neck Surg. 2016;142(1):46-51. doi:10.1001/jamaoto.2015.2845

Importance  Limited data exist on performing major oral cavity resections and reconstructions without elective tracheotomy.

Objectives  To describe a group of patients who successfully underwent major microvascular mandibular reconstruction without an elective tracheotomy and to perform a literature review to identify commonalities between our group and the available literature to identify potential common factors that might contribute to the success of this approach.

Design, Setting, and Participants  Case series with retrospective medical chart review of 15 patients who underwent fibula microvascular free flap reconstruction of mandibular defects without tracheotomy between 2000 and 2014 (the most common indication was osteoradionecrosis) conducted at a tertiary referral hospital center.

Exposures  Mandibular reconstruction with fibula free flap without elective tracheotomy.

Main Outcomes and Measures  Perioperative morbidity and mortality with a focus on airway management and perioperative complications.

Results  The median age of 15 patients (11 males and 4 females) at the time of reconstruction was 42 years (range, 10-64 years). The indication for surgery was nonmalignant pathologic abnormalities in 8 patients (53%), osteosarcoma in 4 patients (27%), and oral cavity squamous cell carcinoma in 3 patients (20%). All patients were intubated endonasally and, excepting 1 pediatric case, were extubated the day following surgery. The fibula spanned the parasymphysis and/or symphysis in 2 patients, and was limited to the mandibular body in others (mean length, 7.6 cm [range, 4.0-15.0 cm]). The flap design was osteocutaneous in 3 patients and osseous in the rest. No patient required reintubation or tracheotomy. No complications due to endonasal intubation occurred. The average hospital length of stay was 11 days.

Conclusions and Relevance  Major oral cavity resection and reconstruction with microvascular free flaps can be performed safely without elective tracheotomy in a select group of patients. Limited data exist on patient selection criteria. Further studies are needed to identify favorable factors and develop protocols for safe patient selection.