Clinical Case: Anesthetic Management for Maxillectomy Due to Adenoid Cystic Carcinoma
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Abstract
Introduction: Anesthetic management in oncologic maxillectomy represents a major challenge due to airway complexity, risk of hemorrhage, and anatomical alterations secondary to tumor progression and prior treatments such as chemotherapy and radiotherapy. Adenoid cystic carcinoma is a rare neoplasm characterized by aggressive local invasion and high recurrence rates. Case Presentation: A 59-year-old male with locally advanced adenoid cystic carcinoma of the left hemiface presented with a large facial tumor (≈11×9×8 cm) causing anatomical distortion and predictors of difficult airway (Mallampati III, limited oral opening). Despite prior chemotherapy and radiotherapy, disease progression required suprastructural maxillectomy with orbital exenteration and flap reconstruction. Anesthetic management included intravenous induction, successful orotracheal intubation on first attempt via direct laryngoscopy, and maintenance with inhalational anesthesia, opioids, and dexmedetomidine. Intraoperatively, significant blood loss (≈1200 ml) required transfusion and vasopressor support. Electrolyte disturbances and a cutaneous reaction were managed without major complications. The patient was extubated awake after airway reassessment and had an uneventful postoperative course with adequate pain control and no respiratory compromise. Clinical Findings and Outcomes: The case highlights successful airway management despite multiple predictors of difficulty, effective control of hemorrhage with goal-directed strategies, and favorable postoperative recovery without major complications. Discussion: Maxillectomy in head and neck cancer requires a comprehensive anesthetic approach addressing airway management, hemodynamic stability, bleeding control, and postoperative care. Prior radiotherapy and chemotherapy significantly increase airway difficulty and perioperative risks. Multimodal analgesia and careful fluid management are essential to optimize outcomes and reduce complications. Conclusion: An individualized, multidisciplinary anesthetic strategy is essential in complex oncologic maxillectomy. Careful preoperative planning, anticipation of complications, and application of multimodal perioperative management can achieve favorable outcomes even in high-risk patients.
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