부산대 치의학전문대학원 김욱규 교수<사진>가 지난 7일부터 11일까지 캐나다 밴쿠버에서 개최된 2023 국제구강악안면외과학회(IAOMS) 학술대회에 참가해 논문 2편을 발표했다.
김 교수는 이번 IAOMS 학술대회에서 ‘Screen Study of Target genes for Immunotherapy in Oral Squamous Cell Carcinoma Patients based on mRNA Expression Microarray Data’ 포스터 1편과 ‘Efficacy of Tracheostomy for Respiratory Management in Patients with Advanced Cancer’ 제목의 구연 1편을 발표했다.
덴탈이슈는 김 교수의 구연발표 논문을 요약 게재해 독자에게 최신 치의학 경향을 전하고자 한다. [편집자 주]
Efficacy of tracheostomy for respiratory management in patients with advanced oral cancer
김욱규·황대석(부산대 구강악안면외과학교실), 유미현(부산대 구강병리학교실)
Purpose: Oral cancer surgery carries a high risk of upper airway obstruction. The use of elective tracheostomy in major head and neck surgery is well established, although the actual use of elective tracheostomy is variable. Resection of the mandible, tongue, and floor of mouth cares a particularly high risk since surgery in these areas may cause bleeding that may lead to upper airway obstruction as well as upper airway edema in pharynx and the posterior tongue. The purpose of the present study was to evaluate the use of tracheostomy in oncological patients undergoing oral cancer surgery at Pusan National University Dental Hospital.
Material and Method: The subjects of this study were 20 oral cancer patients who underwent oral and maxillofacial surgery from 2010 to 2021 at Pusan National University. Age, sex, underlying disease, chest x-ray findings, location and size of primary lesion, type of resection, type of flap, type of cervical ablation, postoperative complications, etc., focusing on cases for which surgical resection and reconstruction are indications was investigated and analyzed with the Cameron M. scoring system.
Results: In this study, the average score of 10 patients who underwent tracheostomy was 10.2, and the average score of patients who did not underwent tracheostomy was 7.5. According to the Cameron M. scoring system, patients with a score of 8 or higher are classified as high-risk patients, and those with a score of less than 8 are classified as low-risk patients. Also, the patient who did not plan tracheostomy before surgery, but showed respiratory depression due to postoperative edema, had a score of 9, which was on the borderline between high-risk and low-risk groups.
Conclusion: A proper tracheostomy indication is needed, to facilitate the recovery and the postoperative management of the patients. the major advantages of performing an elective tracheotomy in our opinion is to facilitate urgent treatment whether it is an urgent lifesaving treatment or an urgent return to the operating room for flap salvage. Another advantage for having a tracheostomy is the prevention of pneumonia and the reduction of risk for iatrogenic flap disruption during reintubation.
Keywords: Tracheostomy, Oral cancer, Respiration, Airway obstruction, Intubation
아래 그림 5개= 10명은 기관절개술을 수술 전 시행한 경우, 10명은 기관절개술을 시행하지 않은 경우를 분석한 도표를 표시, 우리 환자들 경우에서도 Dr. Cameron Score 8이 넘으면 술전 기관절개술을 하고 수술함이 안전함을 알 수 있었다.
