Total airway obstruction after maxillomandibular advancement surgery for obstructive sleep apnea.

Abstract

Maxillomandibular advancement surgery is a surgical option for treating obstructive sleep apnea, especially in patients intolerant to, or noncompliant with, continuous positive airway pressure. We describe a patient who underwent maxillomandibular advancement surgery, met criteria for tracheal extubation, and subsequently developed total airway obstruction immediately upon extubation. 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. Nasopharyngolaryngoscopy should be performed routinely before extubating these patients to evaluate for pharyngeal edema and hematoma formation. 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.