The effect of free flap surgery for oral cancer on laryngeal grade and intubation difficulty

Brian Rezel Carr; Timothy Wayne Neal; Robert Hermann; David Schwitzer; Jonathan Jelmini; Roderick Y Kim

doi:10.1016/j.oooo.2024.03.005

The effect of free flap surgery for oral cancer on laryngeal grade and intubation difficulty

Oral Surg Oral Med Oral Pathol Oral Radiol. 2024 Mar 20:S2212-4403(24)00123-8. doi: 10.1016/j.oooo.2024.03.005. Online ahead of print.

Authors

Brian Rezel Carr¹, Timothy Wayne Neal², Robert Hermann², David Schwitzer³, Jonathan Jelmini³, Roderick Y Kim²

Affiliations

¹ Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: brian.carr@phhs.org.
² Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
³ Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Hospital, Fort Worth, TX, USA.

PMID: 38749876
DOI: 10.1016/j.oooo.2024.03.005

Abstract

Objective: The purpose of this study was to evaluate the change in laryngeal grade and intubation difficulty at subsequent surgery in patients with prior free flap reconstruction for oral cancer.

Study design: This retrospective case series included patients with a diagnosis of oral cancer who underwent free flap reconstruction (FFR) (S1) followed by a subsequent surgery (S2) which required intubation. The primary predictor variable was FFR. The primary outcome variable was the change in laryngeal grade, based on the classification of Cormack and Lehane, after FFR. Secondary outcomes were intubation difficulty and number of intubation attempts.

Results: Thirty-three patients were included in the study. At S1, the average laryngeal grade was 1.1. There were 5 difficult intubations. The average time to S2 was 19 months. At S2, average laryngeal grade was 1.4. There were 17 difficult intubations. Analysis showed a significant association between FFR and a more obstructed view of the glottis at S2 (P = .007; 95% CI 0.101-0.808). FFR increased the odds of having >1 intubation attempt nearly 7-fold (OR 6.74; 95% CI 1.35-33.75), and the odds of a difficult intubation nearly 6-fold (OR 5.95; 95% CI 1.84-19.19) at S2, both of which were significant (P = .011 and P = .002, respectively) CONCLUSIONS: This investigation found an association between FFR for patients with oral cancer and a higher laryngeal grade - that is, a more obstructed view of the glottis - at subsequent surgery, in addition to increased intubation difficulty and greater number of intubation attempts.