Head and Neck Cancers Coverage from Every Angle
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Is There a Link Between Head/Neck Radiotherapy and Difficult Tracheal Intubation?

By: Sylvia O'Regan
Posted: Monday, August 19, 2019

A retrospective study of 472 patients with oral cavity or oropharyngeal cancer tested the hypothesis that a history of head/neck radiotherapy may be linked to high rates of difficult tracheal intubation. Conducted by Gang Zheng, MD, of The University of Texas MD Anderson Cancer Center, and colleagues, the study found that such a history did not increase the incidence of difficult tracheal intubation in patients with these head/neck cancers, despite a significant association between a history of head/neck radiotherapy and restriction of neck range of motion.

“[The] Mallampati score may be a sensitive measurement for difficult tracheal intubation in this patient population,” the investigators concluded. (The Mallampati score, a simple test often used in assessing patients for obstructive sleep apnea, was used in this study to predict the ease of intubation.)

The study drew on data from a cancer registry containing records of 4,011 adults—aged 18 or older at the time of surgery—who had oral cavity or oropharyngeal cancer. The 472 selected patients were divided evenly into two groups: those who had a history of head/neck radiotherapy before surgery and those who had upfront surgery without it.

The investigators found that 12.7% patients in the study had difficult tracheal intubation. However, the proportion of patients with difficult tracheal intubation did not differ significantly between the two groups. They also found that the percentage of patients who had restricted neck range of motion in the history of head/neck radiotherapy group was significantly higher than in the control group (22.3% vs. 11.0%; P = .001). “Patients who had Mallampati scores of 3 or 4 had a significantly higher rate of difficult tracheal intubation than did patients with Mallampati scores of 1 or 2 (17.8% vs. 8.7%; P = .004),” the investigators added.

Disclosure: The study authors reported no conflicts of interest.

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