head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing
ISSN: 1312-773X (Online)
Issue: 2018, vol. 24, issue3
Subject Area: Dental&Oral Medicine
DOI: 10.5272/jimab.2018243.2142
Published online: 03 September 2018

Original article

J of IMAB. 2018 Jul-Sep;24(3):2142-2148
Rowland Agbara1, 2ORCID logo Corresponding Autoremail, Benjamin Fomete2ORCID logo, Obiadazie Athanasius-Chukwudi2, Omeje Uchenna-Kelvin3, Onyebuchi Polycarp2, Idowu Enoch Abiodun1.
1) Department of Dentistry, Faculty of Medical Sciences, University of Jos, Plateau state, Nigeria.
2) Department of Oral and Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna state, Nigeria.
3) Department of Dental and Maxillofacial Surgery, Aminu Kano University Teaching Hospital, Kano, Nigeria.

Purpose: Despite advances in anesthetic techniques, health resource environment still face challenges in achieving safe anesthesia due to limited facilities and skilled personnel. This study highlights the value of open tracheostomy in oral/maxillofacial surgery in a health resource-limited setting.
Materials and Methods: Maxillofacial surgery patients who had a tracheostomy in a regional University Teaching Hospital between February 1999 and August 2017 were retrospectively studied. Details sourced included age, sex, surgical condition, indication for tracheostomy and complications. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA). Findings from descriptive statistics were represented in the form of tables and charts.
Results: A total of 51 patients had an open tracheostomy and this consisted of 28 (54.9%) males and 23 (45.1%) females. The main anesthetic indication was preoperative difficult airway assessment, and there was more elective (n=45; 88.2%) than emergency tracheostomies. Orofacial tumors (n=30; 58.9%) were the major conditions managed. More patients with mallampati class IV (n=18; 69.2%) had tracheostomy. About 98.0% (n=50) of the patients had a temporary tracheostomy and the main complications noted were mortality, surgical emphysema and hemorrhage.
Conclusion: In resource limited environments, the maxillofacial surgical team frequently has little facility to work with and often face challenging cases. Although these patients can be safely anaesthetized using less invasive methods in health resource-rich settings, tracheostomy offers surgeons in our environment an opportunity to improve the quality of life of these patients who otherwise cannot be safely anaesthetized due to limited facilities or skilled manpower.

Keywords: Tracheostomy, Maxillofacial, Tumor, Health resources,

pdf - Download FULL TEXT /PDF 976 KB/
Please cite this article as: Agbara R, Fomete B, Athanasius-Chukwudi O, Uchenna-Kevin O, Onyebuchi P, Idowu EA. Open tracheostomy in oral and maxillofacial surgery in a resource limited setting: the hope of whom little is given. J of IMAB. 2018 Jul-Sep;24(3):2142-2148.
DOI: 10.5272/jimab.2018243.2142

Corresponding AutorCorrespondence to: Dr Rowland Agbara, Department of Dentistry, University of Jos, Plateau state, Nigeria; E-mail: row_prof@yahoo.com,

1. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis, RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013 Feb; 118(2):251-70. [PubMed] [CrossRef]
2. Kheterpal S, Healy D, Aziz MF, Shanks AM, Freundlich, RE, Linton F, et al. Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group. Anesthesiology. 2013 Dec;119(6):1360-9. [PubMed] [CrossRef]
3. Adnet F, Borron SW, Racine SX, Clemessy JL, Fournier JL, Plaisance P, et al. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology. 1997 Dec;87(6):1290-7. [PubMed]
4. el-Ganzouri AR, McCarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg. 1996 Jun;82(6):1197-204. [PubMed]
5. Collins SR. Direct and Indirect Laryngoscopy: Equipment and Techniques. Respir Care. 2014 Jun; 59(6):850-64. [PubMed] [CrossRef]
6. Harun-or-Rashid Md, Taous A. Comparative study on complications of emergency and elective tracheostomy. Bangladesh J Otorhinolaryngol. 2015 Oct;21(2):69-75. [CrossRef]
7. Graham JS, Mulloy RH, Sutherland FR, Rose S. Percutaneous versus Open Tracheostomy: A Retrospective Cohort Outcome Study. J Trauma. 1996 Aug;41(2):245-50.
8. Engels PT, Bagshaw SM, NMeier M, Brindley PG. Tracheostomy: from insertion to decannulation. Can J Surg. 2009 Oct;52(5):427-33. [PubMed]
9. Akinmoladun V, Arotiba J, Onakoya P, Adeyemo A, Sotunmbi P. An Evaluation of Open Tracheostomy in Oral and Maxillofacial Surgery. Niger J Surg Sci. 2007; 17:96-100.
10. Salgarelli AC, Collini M, Bellini P, Cappare P. Tracheostomy in Maxillofacial Surgery: A Simple and Safe Technique for Residents in Training. J Craniofac Surg. 2011 Jan;22(1):243-6. [PubMed] [CrossRef]
11. Gilyoma JM, Balumuka DD, Chalya PL. Ten-year experiences with Tracheostomy at a University teaching hospital in NorthwesternTanzania: A retrospective review of 214 cases. World J Emerg Surg. 2011 Nov; 6:38. [PubMed] [CrossRef]
12. Ali MA, Ibrahim IA. Five-Year Experience with Tracheostomy at ENT-Khartoum Teaching Hospital in Sudan. Merit Res J Med Med Sci. 2016 Feb;4(2):92-7.
13. Kodiya AM, Afolabi AO, Grema US, Ajayi IO, Ngamdu YB, Labaran SA. Tracheostomy in Northern Nigeria - A Multicentre Review. East Cent Afr J Surg. 2013 Apr;18(1):65-70.
14. Amusa YB, Akinpelu VO, Fadiora SO, Agbakwuru EA. Tracheostomy in surgical practice: Experience in a Nigerian Tertiary Hospital. West Afr J Med. 2004 Jan-Mar;23(1):32-4. [PubMed]  
15. Haspel AC, Coviello VF, Stevens M. Retrospective study of tracheostomy indications and perioperative complications on oral and maxillofacial surgery service. J Oral Maxillofac Surg. 2012 Apr;70(2):890-5. [PubMed] [CrossRef]
16. Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia. 2004 Jul;59(7):67-94. [PubMed] [CrossRef]
17. Hall CE, Shutt LE. Nasotracheal intubation for head and neck surgery. Anaesthesia. 2003 Mar;58(3):249-56. [PubMed]
18. Zhang J, Lamb A, Hung O, Hung C, Hung D. Blind nasal intubation: teaching a dying art. Can J Anaesth. 2014 Nov;61(11):1055-6. [PubMed] [CrossRef]
19. Yoo H, Choi JM, Jo JY, Lee S, Jeong SM. Blind nasal intubation as an alternative to difficult intubation approaches. J Dent Anesth Pain Med. 2015 Sep;15(3):181-4. [PubMed] [CrossRef]
20. Batra YK, Mathew PJ. Airway Management with Endotracheal Intubation (Including Awake Intubation and Blind Intubation). Indian J Anaesth. 2005 Aug;49(4):263-8.
21. Chemsian RV, Bhananker S, Ramaiah R. Videolaryngoscopy. Int J Crit Illn Inj Sci. 2014 Jan-Mar;4(1):35-41. [PubMed] [CrossRef]
22. Cheyne DR, Doyle P. Advances in laryngoscopy: rigid indirect laryngoscopy. F1000 Med Rep. 2010 Aug; 2: 61. [PubMed] [CrossRef]
23. Cole RR, Aguilar EA 3rd. Cricothyroidotomy vs tracheostomy: An Otolaryngologist perspective. Laryngoscope. 1988 Feb;98(2):131-5. [PubMed] [CrossRef]
24. Dillon JK, Christensen B, Fairbanks T, Jurkovich G, Moe KS. The emergent surgical airway: cricothyrotomy vs. tracheotomy. Int J Oral Maxillofac Surg. 2013 Feb;42(2):204-8. [PubMed] [CrossRef]
25. Waldron J, Padgham ND, Hurley SE. Complications of emergency and elective tracheostomy: a retrospective study of 150 consecutive cases. Ann R Coll Surg Engl. 1990 Jul;72(4):218-20. [PubMed]
26. Santus P, Gramegna A, Radovanovic D, Raccanelli R, Valenti V, Rabbiosi D, et al. A systematic review on tracheostomy decannulation: a proposal of a quantitative semiquantitative clinical score. BMC Pulm Med. 2014 Dec;14:201 [PubMed] [CrossRef]
27. Hammarfjord O, Chee N, Norton J, Stassen LF. Tracheostomies for oral and maxillofacial oncology operations: a retrospective study of 125 cases of early primary closure of the tracheostomy site. Br J Oral Maxillofac Surg. 2013 Sep;51(6):e79-e136.
28. Christopher K. Tracheostomy decannulation. Respir Care. 2005 Apr;50(4):538-41. [PubMed]
29. Cetto R, Arora A, Hettige R, Nel M, Benjamin L, Gomez CM, et al. Improving tracheostomy care: a prospective study of the multi-disciplinary approach. Clin Otolaryngol. 2011 Oct;36(5):482-8. [PubMed] [CrossRef]
30. Coln CE, Purdue GF, Hunt JL. Tracheostomy in the young pediatric burn patient. Arch Surg. 1998 May;133(5):537-9. [PubMed] [CrossRef].

Received: 15 February 2018
Published online: 03 September 2018

back to Online Journal