The difference between delayed extubation and tracheostomy in post-operative sleep apnea after glossectomy or laryngectomy

Background: Patients with cancer of the tongue or larynx require glossectom ies or laryngectomies and subsequent reconstruction. These procedures remov e part of the patient's upper airway. In cancer of the tongue, the removed part of the airway is substituted by a flap of their skin. Post-operatively , it is possible that the patients have problems respiring comfortably. In addition to this, long surgical procedures may simply interfere with their circadian rhythm. To elucidate the possible change in their post-operative respiration, we monitored the patient's respiratory pattern with an apnea m onitor. Methods: We attached an apnea monitor to the patients and recorded their re spiratory pattern and arterial oxygen saturation. The patients were monitor ed for a total of five days: three days prior to the operation, one day bef ore the operation, the day of operation, two days after, and on the fourth day after the operation, The period of monitoring was from 8:00 p.m. to 6:0 0 a.m. the next morning. Results: Sixteen patients completed this study. The patients whose tube was extubated after glossectomy showed frequent apnea, low mean oxygen saturat ion and low comfort score as compared to the patients with tracheostomy aft er laryngectomy, Because two failed cases of free skin flap were among the former, it is possible that the frequent apnea is a factor of failed free s kin graft after glossectomy and laryngectomy. Conclusion: Further studies are required to improve the patient's respirati on during their sleep after tracheal extubation in glossectomy.