Perioperative airway management in patients with maxillofacial and cervical venous malformation involving isthmus faucium area

Abstract

Data of patients with maxillofacial and jugular venous malformations involving isthmus faucium area from January 2012 to July 2016 were collected.Patients were questioned about the medical history before operation, and the airway was adequately evaluated.The patients diagnosed as having non-difficult airways were endotracheally tubed using fast induction of anesthesia.Tracheal intubation was performed using fast induction of anesthesia combined with topical anesthesia after visual laryngoscopy in the patients assessed as having difficult airways.Endotracheal intubation was guided with a visual hard endoscope or a fibrobronchoscope in the patients with difficulty in opening mouth after multiple treatments.Postoperative airway management was as follows: the tracheal tube was removed after extubation, the tracheal tube was retained for 24-48 h, or preventive tracheotomy was performed.Oxygen was inhaled by mask.A total of 157 patients were included in this study, 55 patients diagnosed as having difficult airways, and among the 55 patients, 87% cases were intubated after visual laryngoscopy and 13% cases received tracheotomy.There were 10 patients with difficulty in opening mouth after multiple treatments and 5 cases underwent tracheotomy in the outer hospital.Sixteen patients presented with a transient increase in airway pressure during intraoperative injection of anhydrous ethanol.There were 106 cases in whom the tracheal tube was removed immediately after emergence, and among them, 32.1% cases needed tongue traction and 2.8% cases underwent emergency tracheotomy after extubation.Thirty-eight patients needed to retain the tracheal tube for 24-48 h after operation, and among them, 37% cases needed tongue traction and 3% cases required emergency tracheotomy after extubation.Thirteen cases underwent preventive tracheotomy.The preoperative visit and assessment are especially important, appropriate airway management strategies should be developed, vital signs should be closely observed during operation, and the timing of extubation should be grasped for this type of patients, and the SpO2 and airway pressure should be mainly observed during operation especially for the patients who underwent anhydrous ethanol ablation. Key words: Vascular malformation; Airway management