Safety of bronchoscopy in patients with head and neck malignancies

Bronchoscopy for lung diseases in patients with head and neck cancers may present a challenge due to swelling or vulnerability of the tissue, limited mouth opening or scarring, vocal fold immobility and contracture in the region of the pharynx or larynx. In this retrospective study, 63 patients with head and neck cancers who underwent bronchoscopies for various lung diseases from November 2022 until February 2024 in the Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, were enrolled. Performance and complications of the bronchoscopy are reported. Overall, 63 patients (mean age 65.8 ± 9.2 years) with head and neck cancers (oral cavity n = 27, 42.9%; pharyngeal n = 18, 28.6%; laryngeal n = 17, 27.0%; salivary gland n = 1, 1.6%) underwent 73 bronchoscopies (lavage n = 73, 100%; endobronchial biopsy n = 17, 23.3%; transbronchial biopsy n = 13, 17.8%; EBUS-TBNA n = 33, 45.2%, stent implantation n = 1, 1.4%; stent explantation n = 1, 1.4%;). Forty (63.5%) patients had undergone surgery, and 48 (76.2%) had received radiotherapy for the head and neck cancer. Out of 73 bronchoscopies, 22 (30.1%) were performed under sedation and 51 (69.9%) under general anesthesia (laryngeal mask n = 19, 26.0%; endotracheal tube n = 13, 17.8%; rigid bronchoscopy n = 2, 2.7%; via tracheostoma n = 17, 23.3%). No complications occurred in 97.3% ( n = 71) procedures, whereas the following adverse events were observed during 2.7% ( n = 2) procedures: respiratory decompensation after stent removal due to bilateral vocal fold paralysis with the need for tracheostomy post-bronchoscopy; respiratory decompensation under sedation requiring discontinuation of the bronchoscopy. Bronchoscopy in patients with head and neck cancers is a safe procedure. However, it requires a precise risk-benefit assessment by an interdisciplinary team of ENT surgeons, anesthesiologists and pulmonologists prior to the procedure, including, if necessary, awake flexible video- pharyngolaryngoscopy.