Abstract
Airway management is often difficult in patients with severe obesity. Approach to the trachea is interfered with by thickened adipose tissue during tracheotomy and there is a risk of dislocation of the tracheal cannula from the tracheal stoma at the flexion and extension site of the neck. We report here a case of airway management in a patient with severe obesity using tracheotomy combined with lipectomy in the perioperative period of advanced lower gingival cancer.
The patient was a 43-year-old man. The purpose of his visit was treatment of lower gingival cancer diagnosed previously at a local dental clinic. He presented with the complication of severe obesity （height 171cm; body weight 108kg; body mass index 36.8）. CT scan showed that the distance from the skin surface to the trachea was about 5cm at the level of the second tracheal cartilage ring. After the clinical examination, the patient was diagnosed as left lower gingival cancer （T4aN2bM0）. We performed tracheotomy, segmental resection of the mandible, modified radical neck dissection, and finally reconstructed the mandible with a titanium plate and anterolateral thigh flap. Medial tracheotomy was carried out with transverse incision and lipectomy to prevent dislocation of the tracheal cannula during the operation. After surgery, we used an adjustable tracheal cannula to fit the insertion length. On the fifteenth day after surgery, we terminated the airway management with tracheotomy because the patient’s condition had improved significantly.
