First do no harm: should routine tracheostomy after oral and maxillofacial oncological operations be abandoned?

Tracheostomy is traditionally used to secure the airway after major oral and maxillofacial oncological operations. In our unit, as an alternative, patients are intubated overnight without tracheostomy. We reviewed the case notes of 55 patients who had had a major intraoral resection, neck dissection, and reconstruction with a free flap. All patients were extubated and fit for transfer to the ward the following morning. We conclude that overnight intubation is a safe alternative to tracheostomy, and that the routine use of tracheostomy for oral and maxillofacial oncological operations should be used only for a few selected cases.