Strategic De-tethering: Serial Airway Transitions and Reinforced Conduits in Radical Mandibular "Commando" Reconstruction
ASA Poster Gallery. Zia M. 10/19/26; 4233293; M2434
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Abstract
Discussion Forum (0)
Type: Medically Challenging Cases 130: Fundamentals - Monitor 10 (Non-CME)
Topic: Fundamentals of Anesthesiology (FA)
Maida Zia, MD1, Alexander Zazaian, MD1, Nazia Siddiqui, MD2, Sandeep Krishnan, MD3.
1Anesthesiology, Wayne State University, Detroit, MI, USA, 2Wayne State University, TROY, MI, USA, 3Wayne State University, Birmingham, MI, USA.
Radical mandibular resections using visor-flaps create a unique "tethering" conflict: oral ETTs prevent cephalad mandibular angle-to-angle tissue reflection required for exposure. To facilitate our patient’s surgical plan, we initially placed an 8.0 oral ETT but quickly transitioned, via surgical tracheostomy, to a 7.0 spiral-reinforced ETT. This "un-tethering" allowed surgical access while the tube’s reinforcement prevented luminal collapse under the weight of reflected tissues. At case end, a 6.0 cuffed tracheostomy tube was placed to provide definitive protection against post-operative floor-of-mouth edema. This case highlights how collaborative, tactical, airway transitions enable the extreme anatomical manipulation required for complex facial salvage.
Topic: Fundamentals of Anesthesiology (FA)
Maida Zia, MD1, Alexander Zazaian, MD1, Nazia Siddiqui, MD2, Sandeep Krishnan, MD3.
1Anesthesiology, Wayne State University, Detroit, MI, USA, 2Wayne State University, TROY, MI, USA, 3Wayne State University, Birmingham, MI, USA.
Radical mandibular resections using visor-flaps create a unique "tethering" conflict: oral ETTs prevent cephalad mandibular angle-to-angle tissue reflection required for exposure. To facilitate our patient’s surgical plan, we initially placed an 8.0 oral ETT but quickly transitioned, via surgical tracheostomy, to a 7.0 spiral-reinforced ETT. This "un-tethering" allowed surgical access while the tube’s reinforcement prevented luminal collapse under the weight of reflected tissues. At case end, a 6.0 cuffed tracheostomy tube was placed to provide definitive protection against post-operative floor-of-mouth edema. This case highlights how collaborative, tactical, airway transitions enable the extreme anatomical manipulation required for complex facial salvage.
Type: Medically Challenging Cases 130: Fundamentals - Monitor 10 (Non-CME)
Topic: Fundamentals of Anesthesiology (FA)
Maida Zia, MD1, Alexander Zazaian, MD1, Nazia Siddiqui, MD2, Sandeep Krishnan, MD3.
1Anesthesiology, Wayne State University, Detroit, MI, USA, 2Wayne State University, TROY, MI, USA, 3Wayne State University, Birmingham, MI, USA.
Radical mandibular resections using visor-flaps create a unique "tethering" conflict: oral ETTs prevent cephalad mandibular angle-to-angle tissue reflection required for exposure. To facilitate our patient’s surgical plan, we initially placed an 8.0 oral ETT but quickly transitioned, via surgical tracheostomy, to a 7.0 spiral-reinforced ETT. This "un-tethering" allowed surgical access while the tube’s reinforcement prevented luminal collapse under the weight of reflected tissues. At case end, a 6.0 cuffed tracheostomy tube was placed to provide definitive protection against post-operative floor-of-mouth edema. This case highlights how collaborative, tactical, airway transitions enable the extreme anatomical manipulation required for complex facial salvage.
Topic: Fundamentals of Anesthesiology (FA)
Maida Zia, MD1, Alexander Zazaian, MD1, Nazia Siddiqui, MD2, Sandeep Krishnan, MD3.
1Anesthesiology, Wayne State University, Detroit, MI, USA, 2Wayne State University, TROY, MI, USA, 3Wayne State University, Birmingham, MI, USA.
Radical mandibular resections using visor-flaps create a unique "tethering" conflict: oral ETTs prevent cephalad mandibular angle-to-angle tissue reflection required for exposure. To facilitate our patient’s surgical plan, we initially placed an 8.0 oral ETT but quickly transitioned, via surgical tracheostomy, to a 7.0 spiral-reinforced ETT. This "un-tethering" allowed surgical access while the tube’s reinforcement prevented luminal collapse under the weight of reflected tissues. At case end, a 6.0 cuffed tracheostomy tube was placed to provide definitive protection against post-operative floor-of-mouth edema. This case highlights how collaborative, tactical, airway transitions enable the extreme anatomical manipulation required for complex facial salvage.
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