Title: Airway management for oral cancer - techniques and challenges
Abstract:
Oral cavity and oropharyngeal cancer impose significant threat to airway management. Oral cancer patients have a potentially difficult airway but, if managed properly during perioperative period, morbidity and mortality can be reduced or avoided. To ensure safety, a tailored and collaborative approach is essential. Oral cancer patients can be managed safely without the routine use of a tracheotomy. Nasotracheal intubation is a safe alternative to tracheotomy in oral cancer patients except in some selected patients. The assessment of difficult airway is done through history, general physical examination, physical examination of the airway, specific tests, and radiologic assessment. The physical examination of the airway begins by visually inspecting the face and neck, followed by assessing mouth opening and oropharyngeal anatomy, evaluating the patient's neck range of motion for assuming the sniffing position, examining the submandibular space, and finally assessing the patient's ability to slide the mandible. The anaesthesia team usually faces the challenges in managing these cases, particularly with difficult mask ventilation, supraglottic airway insertion, laryngoscopy and intubation, and potential considerations for a difficult tracheotomy. To foretell a difficult airway, several independent bedside tests like Mallampatti- Samson Young classification, the sternomental distance, the upper?lip bite test, the mouth openness, etc. have been described. However, no independent test has been able to consistently predict the difficult airway. Wilson score, which is a combination of many independent tests, has recently gained the popularity. In carcinoma of oral cavity the patient may presented with intraoral mass and reduce mouth opening, making conventional intubation challenging. It can lead to tongue displacement, limited oral cavity space, supraglottic obstruction, and difficulty in mask ventilation. A meticulous planning of airway either by fibre-optic scope or VL or direct laryngocopy is indicated in these cases.
