Emergency Management Protocols for Major Complications after Oral and Maxillofacial Surgery: Emphasis on Airway and Bleeding Control

Background Major postoperative complications following maxillofacial surgery, particularly severe bleeding and airway obstruction, remain life-threatening events despite advances in surgical trechniques and perioperative care[1, 2]. Delayed response to these events can lead to fatal complications or even death. However, standardized institutiohnal protocols integrating bleeding control and airway management are lacking. Therefore, this study retrospectively analyzes cases of postoperative major hemorrhage and airway obstruction that occurred at a tertiary hospital, and through a review of the literature, aims to establish safer postoperative management guidelines. Methods In this study, “major surgery” primarily refers to procedures such as malignant tumor resection, orthognathic surgery, and fracture surgery. A retrospective cohort study was conducted including patients who underwent maxillofacial major surgery at a tertiary university dental hospital over a 15-year period. Major bleeding events were defined as postoperative hemorrhage requiring reoperation or angiography with embolization. Major airway events were defined as unplanned reintubation, emergency tracheostomy. Patients who underwent malignant tumor resection in the oral and maxillofacial region were included in the analysis. Among the patients who underwent malignant tumor resection, those who required emergency tracheostomy following surgery were classified as the case group, whereas those who underwent planned elective tracheostomy prior to surgery were assigned to the control group. Results Postoperative bleeding requiring intervention occurred in 20 cases, with 70% associated with major surgery. Five of the eight patients who underwent orthognathic surgery required emergency bleeding control operation for hemorrhage within 72 hours postoperatively. Most bleeding events occurred independently of patient-related coagulation disorders, indicating a stronger association with surgical extent and technique. Transarterial embolization was performed in 13 cases; however, only one case was related to emergency postoperative hemorrhage. Tracheostomy was performed in 24 cases, including 13 related to oral cancer surgery. Emergency tracheostomy was most commonly required in patients with malignant tumors or severe infections. The mean Cameron score was 6.00 in the five patients in the case group, whereas a mean score of 6.17 was observed in six patients in the control group[3]. Conclusion In oral and maxillofacial surgery, postoperative hemorrhage may occur regardless of patient comorbidities, necessitating careful perioperative bleeding control. Although not included in our institutional protocol, prior studies support angiographic evaluation with selective arterial embolization as a reliable option in cases at high risk for postoperative bleeding. Tracheostomy should be considered a proactive airway management strategy guided by tools such as the Cameron scoring system, particularly in elderly patients and those undergoing extensive surgery[3]. However, the score should not be used in isolation, and careful postoperative monitoring is required even in patients below the recommended threshold. A stepwise, integrated approach to postoperative bleeding and airway management, incorporating structured bleeding control, early airway protection, and timely consideration of transarterial embolization, may improve patient safety and outcomes.