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GENERAL ARTICLES

Total Airway Obstruction After Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea

Patrick W. Hogan, DO^*, and Maged Argalious, MD

From the *Division of Anesthesiology and Critical Care Medicine; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; and Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio.

Address correspondence and reprint requests to Maged Argalious, MD, Department of General Anesthesiology/E31, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195. Address e-mail to argalim{at}ccf.org.

BACKGROUND: Maxillomandibular advancement surgery is a surgical option for treating obstructive sleep apnea, especially in patients intolerant to, or noncompliant with, continuous positive airway pressure.

METHODS: We describe a patient who underwent maxillomandibular advancement surgery, met criteria for tracheal extubation, and subsequently developed total airway obstruction immediately upon extubation.

RESULTS: Before extubation, an airway exchange catheter was used and reintubation occurred without difficulty. The patient was brought back to the operating room for evacuation of a hypopharyngeal hematoma, as well as revision and replacement of fractured hardware.

CONCLUSIONS: Nasopharyngolaryngoscopy should be performed routinely before extubating these patients to evaluate for pharyngeal edema and hematoma formation.

IMPLICATIONS: Maxillomandibular advancement (MMA) surgery is increasingly used as a surgical option in the treatment of obstructive sleep apnea. We report a case of life-threatening airway obstruction after MMA and discuss the etiology of airway compromise after these surgeries.

This article has been cited by other articles:

				C. H. J. Won, K. K. Li, and C. Guilleminault Surgical Treatment of Obstructive Sleep Apnea: Upper Airway and Maxillomandibular Surgery Proceedings of the ATS, February 15, 2008; 5(2): 193 - 199. [Abstract] [Full Text] [PDF]

				C. F. Viozzi Further Thoughts on Airway Management After Maxillomandibular Advancement for Obstructive Sleep Apnea Anesth. Analg., November 1, 2007; 105(5): 1517 - 1517. [Full Text] [PDF]