Head and Neck Issues in Cirrhotic Patients



Head and neck issues in patients with liver failure include upper aerodigestive bleeding, need for tracheostomy, and head and neck cancer. Epistaxis has a higher rate of complications in patients with liver failure. Multiple management options exist for epistaxis. Severe bleeding may need surgical or radiologic intervention. Oral bleeding after dental procedures is common and can usually be managed with local interventions. Critically ill patients with liver failure often need a tracheostomy to avoid complications of prolonged intubation. Tracheostomy should be considered in patients in whom greater than 10 days of continuous mechanical ventilation are anticipated. This should be done by an experienced surgeon in the operating theater. Decannulation should be attempted when the criteria are met. The most common head and neck malignancies in liver failure patients are skin neoplasms, malignancies of the aerodigestive tract, and salivary gland cancers.


Epistaxis Tracheostomy Oral Bleeding Head and neck squamous cell carcinoma Cutaneous cancer Salivary gland cancer Cirrhosis Coagulopathy 


  1. 1.
    Camus M, Jensen DM, Matthews JD, Ohning GV, Kovacs TO, Jutabha R, Ghassemi KA, Machicado GA, Dulai GS. Epistaxis in end stage liver disease masquerading as severe upper gastrointestinal hemorrhage. World J Gastroenterol. 2014;20(38):13993–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Traboulsi H, Alam E, Hadi U. Changing trends in the management of epistaxis. Int J Otolaryngol. 2015;2015:1–7. . Article ID 263987CrossRefGoogle Scholar
  3. 3.
    Rustemeyer J, Bremerich A. Necessity of surgical dental foci treatment prior to organ transplantation and heart valve replacement. Clin Oral Investig. 2007;11(2):171–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Niederhagen B, Wolff M, Appel T. Location and sanitation of dental foci in liver transplantation. Transpl Int. 2003;16(3):173–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014;59(6):895–919.CrossRefPubMedGoogle Scholar
  6. 6.
    De Leyn P, Bedert L, Delcroix M, Depuydt P, Lauwers G, Sokolov Y, van Meerhaeghe A, van Schil P. Tracheotomy: clinical review and guidelines. Eur Assoc Cardiothorac Surg. 2007;32:412–21.CrossRefGoogle Scholar
  7. 7.
    Andriolo BNG, Andriolo RB, Saconato H, Atallah AN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev. 2015. [Cited 1 June 2016]. Available from:
  8. 8.
    Young D, Harrison DA, Cuthbertson BH, Rowan K. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA. 2013;309(20):2121–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Halum SL, Ting JY, Plowman EK, Belafsky PC, Harbarger CF, Ostma GN, Pitman MJ, Lamonica D, Moscatello A, Khosla S, Cauley CE, Maronian NC, Melki S, Wick C, Sinacori JT, White Z, Younes A, Ekbom EC, Sardesai MG, Merati AL. A multi-Institutional analysis of tracheotomy complications. Laryngoscope. 2011;122(1):38–45.CrossRefGoogle Scholar
  10. 10.
    Epstein SK. Late complications of tracheostomy. Respir Care. 2005;50(4):542–9.PubMedGoogle Scholar
  11. 11.
    Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, Brown CA, Brandt C, Deakins K, Hartnick C, Merati A. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013;148(1):6–20.CrossRefPubMedGoogle Scholar
  12. 12.
    Nure E, Frongillo F, Lirosi MC, Grossi U, Sganga G, Avolio AW, Siciliano M, Addolorato G, Mariano G, Agnes S. Incidence of upper aerodigestive tract cancer after liver transplantation for alcoholic cirrhosis: a 10-year experience in an Italian center. Transplant Proc. 2013;45(7):2733–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Ramsay HM, Fryer AA, Hawley CM, Smith AG, Harden PN. Non-melanoma skin cancer risk in the Queensland renal transplant population. Br J Dermatol. 2002;147(5):950–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Penn I. Malignant melanoma in organ allograft recipients. Transplantation. 1996;61(2):274–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med. 2003;348:1681–91.CrossRefPubMedGoogle Scholar
  16. 16.
    Gourin CG, Terris DJ. Head and neck cancer in transplant recipients. Curr Opin Otolaryngol Head Neck Surg. 2004;12(2):122–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Ahn MH, Park S, Lee HB. Suicide in cancer patients within the first year of diagnosis. Psychooncology. 2015;24(5):601–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Wu YS, Lin PY, Chien CY, Fang FM, Chiu NM, Hung CF, Lee Y, Chong MY. Anxiety and depression in patients with head and neck cancer: 6-month follow-up study. Neuropsychiatr Dis Treat. 2016;12:1029–36.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kao HK, Chang KP, Ching WC, Tsao CK, Cheng MH, Wei FC. Postoperative morbidity and mortality of head and neck cancers in patients with liver cirrhosis undergoing surgical resection followed by microsurgical free tissue transfer. Ann Surg Oncol. 2010;17(2):536–43.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Cleveland Clinic Head and Neck InstituteClevelandUSA

Personalised recommendations