Retrospective study of delayed tracheal extubation after oral and maxillofacial free flap transplantation surgery

doi:10.19438/j.cjoms.2025.05.006

Abstract

Abstract: PURPOSE: To evaluate the clinical efficacy of delayed tracheal extubation in oral and maxillofacial tumor resection with simultaneous vascularized free tissue flap transplantation and reconstruction. METHODS: Retrospective review was conducted on 257 patients treated by the same surgical team in Shandong Provincial Hospital between January 2019 and May 2024 for oral and maxillofacial tumor resection combined with vascularized free tissue flap transplantation. Clinical data of patients were collected, postoperative complications were analyzed, and the factors that might affect the postoperative catheter duration of patients were statistically analyzed by using R 4.3.3 software. RESULTS: All 257 patients underwent nasal tracheal intubation under general anesthesia. All postoperative patients with nasotracheal tube were transferred to the intensive care unit(ICU) instead of prophylactic tracheotomy. The nasotracheal tube was delay extubated when the risk of airway obstruction was relieved. A total of 251 patients (97.67%) delayed extubation successfully in the first stage,with an average intubation time was 5.11 days. There were 49 patients (19.07%) who had postoperative complications, including 5 flap vascular crisis, 5 hemorrhage (1.95%), 24 pulmonary inflammation (9.34%), 3 secondary tracheal intubation (1.17%), 2 delayed tracheotomy(0.78%), 1 automatic discharge (0.39%), 9 postoperative delirium (3.50%), 7 postoperative maxillofacial infection (2.72%). The period of postoperative extubation was significantly affected by the difference between benign and malignant lesions, as well as the difference in tumor anatomic locations. CONCLUSIONS: Delayed extubation is a safe and effective airway management strategy for patients who have undergone oral and maxillofacial tumor resection combined with vascularized free tissue flap transplantation, which provides an alternative option for patients who cannot accept postoperative prophylactic tracheotomy.

Key words: Airway management, Oral and maxillofacial tumor resection, Free flap transfer, Prophylactic tracheotomy, Delayed extubation

CLC Number:

R782.05

Yu Lianpin, Huang Shengyun, Liu Junjie, Zhang Weidong, Zheng Peihui, Hou Yali. Retrospective study of delayed tracheal extubation after oral and maxillofacial free flap transplantation surgery[J]. China Journal of Oral and Maxillofacial Surgery, 2025, 23(5): 463-468.

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