Postoperative bleeding in transoral laser microsurgery for upper aerodigestive tract tumors

Objectives: To report the incidence, cause, and outcome of bleeding after transoral laser microsurgery. Study Design: A two-center prospective case series analysis. Subjects and Methods: Seven hundred one patients underwent transoral laser microsurgery for tumors of the oral cavity, pharynx, and larynx from June 1996 through September 2006. Results: Ten patients (1.4%) experienced postoperative bleeding between 0 and 17 days after surgery. Five patients had previously untreated tumors, and five patients had salvage surgery. Two patients (0.3%) had minor bleeding and required observation only. Five patients (0.7%) experienced major bleeding requiring exploration under general anesthesia. Three patients (0.4%) had catastrophic life-threatening bleeds, two of whom died. The bleeding vessel was identified as the lingual artery in four patients, the superior laryngeal artery in two, the facial artery in two, and unknown in two. Conclusions: Bleeding after transoral laser microsurgery is rare but potentially life-threatening.