Airway Management in Microvascular Reconstruction of the Head and Neck: Current Practice Patterns

Objective: To identify current airway management practice patterns during free tissue transfer (FTT) reconstruction of head and neck defects.

Methods: A 27-question survey distributed to American Head and Neck Society (AHNS) members. Correlation between surgeon and patient variables with likelihood to perform tracheotomy and tracheotomy technique were evaluated.

Results: Our survey yielded 151 respondents. The majority (69.5%) reported performing tracheotomy for "most"/"every" FTT case. There was higher likelihood (p < 0.05) toward tracheotomy for patients with poor preoperative pulmonary status, larger defect size, and reconstruction of glossectomy and oropharyngeal defects. Tracheotomy was less likely (p < 0.05) during reconstruction of maxillary or palatal defects. Surgeons in practice for > 10 years were less likely to perform tracheotomy following reconstruction of hemiglossectomy defects (OR 0.36, p = 0.018, 95% CI 0.18-0.72).

Conclusion: This study identified practice patterns of airway management in patients undergoing head and neck FTT reconstruction. There is no current consensus regarding perioperative airway management in these patients.