Abstract
Background : Tracheostomy is usually performed for the purposes of securing the airway and preventing aspiration after surgery in patients with head and neck cancer who have undergone free reconstructive surgery. In order to prevent postoperative airway complications, it is important to recognize when a tracheal stoma should be closed and under what circumstances postoperative complications occur. We therefore conducted a retrospective study to assess postoperative airway management with a tracheostomy orifice in patients with head and neck cancer who underwent free reconstructive surgery.
Methods : Between 2001 and 2010, 71 patients with head and neck cancer receiving free reconstructive surgery underwent tracheostomy after surgery. We investigated differences in duration of the tracheostomy orifice for various diseases/flaps, associations between the area of the flap and duration of the tracheostomy orifice, and the causes of airway complications.
Results : In patients with meso/hypopharyngeal cancer, the duration of the tracheostomy orifice tended to extend in comparison with other cancers. Among the reconstructive flaps, in patients reconstructed with the jejunum and rectus abdominis muscle, the duration of the tracheostomy orifice was significantly extended. The duration of the tracheostomy orifice significantly correlated positively with the area of the flap in patients with tongue cancer. However, the occurrence of airway complications was not associated with the duration of the tracheostomy orifice or type of flap. The occurrence of airway complications increased on postoperative days 7-14 on changing the cuffed tracheostomy tube or following stomal closure.
Conclusion : In patients with meso/hypopharyngeal cancer who underwent reconstructive surgery using the jejunum, and patients who underwent reconstructive surgery with the rectus abdominis muscle, there was no urgency to close the tracheal stoma. Following improvement of the swallowing function and the protective mechanism of the larynx, it may then be appropriate to close the tracheal stoma.
