Anaesthesia for minor surgery in oral cancer: a review

Abstract

<p>Anaesthesia for minor surgery in oral cancer encompasses the perioperative care of patients undergoing a wide range of simple oromaxillofacial surgical procedures involving less extensive or minimally invasive surgery, not requiring major tissue resection and/or complex reconstruction of surgical defects, that are nevertheless essential episodes in patients’ oral cancer treatment pathway, that can generally be performed in a day-case elective surgical setting. These minor procedures include diagnostic tissue biopsies and dental extractions performed in advance of major cancer resection and/or radiotherapy, restorative dental work performed after cancer resection and free flap reconstruction, as well as specialist minimally invasive techniques such as transoral laser microsurgery (TLM) and micrographic surgery. There is currently a paucity of studies and limited existing guidance covering this broad area of anaesthetic practice, largely because these procedures are wide-ranging and do not necessarily fit easily into a discrete subject topic for review. Nevertheless, such minor surgical procedures for oral cancer constitute a significant proportion of the anaesthetic caseload in oromaxillofacial surgical units, such that clinical guidance is warranted. Whilst the surgical procedure being undertaken may be relatively minor, the anaesthetic complexity of these patients must not be underestimated. Thorough airway evaluation is essential (including review of relevant imaging and nasendoscopy), paying particular attention to the anatomical site of the tumour, the potential for distortion of airway structures, and the impact of any previous surgery and/or radiotherapy. The appropriateness for procedures to be undertaken on a day-case basis is a multidisciplinary decision, taking into account patient pathology, comorbidities, the planned procedure, and postoperative requirements.<br></p>