Changing patterns of tracheotomy use in anterior skull base surgery with free tissue reconstruction

Objective: To evaluate how changing patterns of tracheotomy use with free tissue reconstruction of the anterior skull base affect postoperative complications. Design: Retrospective comparison of clinical cohort to historic control group. Setting: Tertiary care medical center. Patients: We reviewed 201 patients with a diagnosis of malignant or locally aggressive benign neoplasms of the nasal cavity and paranasal sinuses between January 1993 and December 2006. Of these, we studied 33 consecutive patients that underwent ablative anterior skull base surgery reconstructed with free tissue transfers. We divided the study group into two cohorts: Group 1, patients treated from 1993-2000, and Group 2, patients treated from 2000-2006. Main Outcome Measures: Tracheotomy use and postoperative complications. Results: There were 16 patients in Group 1 and 17 patients in Group 2. There were 11 patients who received a tracheotomy in Group 1, and only 5 in Group 2 (P=.038). Five patients in either group experienced complications (P=1.000). There was one case of meningitis in Group 1 and no cases in Group 2 (P=.485). There were two cases of pneumocephalus in Group 2 and none in Group 1 (P=.485) and no cases of tension pneumocephalus. Six patients in each group had recurrent disease (P=1.000). There was no statistically significant difference in survival (P=.675). Conclusions: The decreased use of tracheotomy in patients undergoing free tissue transfer reconstruction of anterior skull base defects did not lead to an increase in complications. Routine use of tracheotomy in these patients is unnecessary and should be reserved for selected cases.