Assessing Airway Difficulty in Dilation Procedures for Head and Neck Cancer Population

Monday, October 2, 2023

5:36 PM - 5:42 PM East Coast USA Time

Location: 106BC

Presenting Author(s)

MA

Mohammad Bilal Alsavaf, MD

Research Fellow
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
Columbus, OH, United States

Co-Author(s)

MA

Mohammad Bilal Alsavaf, MD

Research Fellow
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
Columbus, OH, United States
MS

Mayuri Srikanth, BS

Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
AK

Akhil Katragadda, BS

Medical Student
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
Columbus, OH, United States

Senior Author(s)

Apoorva T. Ramaswamy, MD

Assistant Professor
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio - James Cancer Center at Ohio State University Medical Center, Columbus, Ohio
Columbus, OH, United States

Disclosure(s):

Mohammad Bilal Alsavaf, MD: No relevant relationships to disclose.

Introduction: Dysphagia caused by esophageal stenosis continues to be a common complication of head and neck cancer (HNC) treatment. Esophageal dilation in this population can present a challenge for surgeons and anesthesiologists due to airway concerns. In this study, we aim to compare airway difficulty between HNC and non-HNC patients receiving esophageal dilations for the management of dysphagia.

Methods: A retrospective analysis of 231 patients (196 HNC and 35 non-HNC) over the age of 18 who underwent esophageal dilation between 2020-2022 at a single institution was conducted. Data on American Society of Anesthesiologists classification, Mallampati score, Cormack-Lehane classification, oral opening, thyromental distance, cervical range of motion, and difficulty of airway were collected and analyzed.

Results: Of 196 head and neck cancer patients, 36 (20.8%) were assessed as having a difficult airway, while none of the 35 non-HNC patients had a difficult airway, a difference which was statistically different (p < 0.003). Trismus defined by < 3 finger breadth oral opening was of increased frequency in HNC patients (p < 0.02). Among HNC patients, statistically significant association was observed between the development of difficult airway and grade 4 primary tumors (p < .05). We observed a lower number of dilations among patients with difficult airway without statistical significance.

Conclusions: Esophageal dilation in HNC patients presents a challenge for both surgeons and anesthesiologists. Our findings suggest HNC patients may be at risk of anesthetic complications due to difficult airways. This suggests experienced airway practitioners are essential in developing a team with expertise in treating dysphagia in head and neck cancer survivors.