Orthognathic Surgery and Trachaeotomy, Normal?

Question

I am scheduled for orthognathic surgery next week, and my surgeon told me today that, as a precaution, he will make a tiny incision in my neck the day after surgery to help me breathe because the swelling will be so bad afterward. Is this normal? I have never heard of anyone getting a precautionary trachaeotomy after orthognathic surgery. Apparently this guy does it routinely, which makes me think I need a different surgeon. Can anyone advise to whether or not this is normal?

Andre Panossian, MD · Answer

Routine orthognathic surgery may be simple (involving a single jaw) or complex (double jaw).  However, precautionary or routine tracheotomy or crichothyroidotomy is not commonly done or needed.  Severe swelling following surgery is common after orthognathic surgery, which is why most people are admitted to the hospital for 2-3 days to ensure no issues exist with excessive bleeding, pain, or breathing obstruction.

Michael L. Schwartz, MD · Answer

Protecting your airway post operatively is definitely a priority. You need to talk to your surgeon to understand his thought process. If he is expecting a lot of swelling in the tongue base or throat and you will be having your jaws wired shut then in event of emergency they may not be able to reestablish your airway quick enough to help you. I don't know if this is the thought but you should be able to have it explained to you.

Richard P. Rand, MD, FACS (retired) · Answer

Certainly, you need to maintain a safe airway and I know of one craniofacial surgeon who did traceostomies at the time of surgery if he was also doing an extensive cleft lip rhinoplasty along with the orthognathic surgery but your surgery sound like maybe less airway compromise.  If you are uncomfortable, see some other doctors.

Orthognathic Surgery and Trachaeotomy, Normal?

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