Importance of Submental Diversion and Tracheostomy for the Oral and Maxillofacial Surgeon

Abstract

Surgical airway maintenance in a patient with oral and maxillofacial trauma, pathology, or infection may present a technical challenge to the oral and maxillofacial surgeon. Submental diversion and tracheostomy are effective methods that can be performed with low complication rates.1,2 However, outcomes may be affected by surgeon experience and training; thus, it is important to evaluate the proficiency of graduates in their ability to perform the associated procedures. The purpose of this study was to evaluate the level of exposure to surgical airway management in training programs, assess the level of confidence in performing these procedures following completion of training, and determine the perceived importance of the procedures within the oral and maxillofacial surgeon's armamentarium.Email invitations were sent to 1200 active email addresses listed on the American Association of Oral and Maxillofacial Surgeons directory. The survey contained 18 questions assessing the level of oral and maxillofacial surgery training, current scope of practice, clinical experience with surgical airway management, confidence in performing surgical airway management, and views on the importance of competency in surgical airway management. Survey responses from individuals who had completed a CODA-accredited OMS training program in the United States were included for analysis. Descriptive statistics for all survey responses were computed using SPSS v. 27.0 (IBM Corp., Armonk, NY, USA). Bivariate analyses between survey responses were analyzed using Pearson's Chi-square tests.A total of 286 completed surveys from practicing oral and maxillofacial surgeons were included in this study; 81.1% of respondents had greater than 5 years of experience, 10.5% had 5 years or less of experience, and 8.4% were currently in fellowship training. Most (71%) held the majority of their practice in a private practice setting. Interestingly, 91% of oral surgeons reported tracheostomy as an important procedure for the OMS armamentarium, but 50% felt inadequately prepared. Frequency of exposure to tracheostomy and submental diversion procedures during residency was found to be significantly associated with level of comfort in completing the procedures (P = .001 and P = .000, respectively). However, only 44% of oral and maxillofacial surgeons completed 10 or more tracheostomies during residency training, and 6% completed at least 10 submental diversions. Years of post-graduate experience and practice setting were also found to have significant correlations with comfort level in completing tracheostomy and submental diversion.There is a broad range of experience and comfort among oral and maxillofacial surgeons in performing airway procedures. Almost all oral and maxillofacial surgeons feel that tracheostomy and submental diversion are important procedures for the oral and maxillofacial surgeon's armamentarium, but many do not feel comfortable in performing these procedures. The findings identify a potential need for additional emphasis in the training of these procedures during oral and maxillofacial surgery residency.