Maxfacts

Even with the best will and effort it may not always be possible to avoid short or extended periods of time during and/or after maxillofacial treatment when taking food and/or drink by mouth becomes quite impossible, or difficult enough so that insufficient nutrition or hydration would result without further intervention. For a few people non-oral food intake will become a permanent fixture, either as the sole source of nutrition or to supplement insufficient food intake by mouth.

Situations where non-oral feeding may become necessary, typically arise after major maxillofacial surgery and reconstruction, including severe facial trauma after accidents, because of the adverse effects of radiotherapy applied to the head and neck region (especially mucositis), serious infections, or efforts to avoid oral infections after oral surgery.

Principally non-oral feeding approaches include

• parenteral feeding (feeding by an intravenous drip, extremely rare in maxillofacial surgery);
• enteral feeding (for maxillofacial conditions, typically via a feeding tube inserted into the stomach, either inserted
  • through the nose and oesophagus into the stomach (a naso-gastric (NG) feeding tube); or
  • through the wall of the abdomen directly into the stomach (a percutaneous endoscopic gastrostomy (PEG).

Parenteral feeding is much more rarely used in maxillofacial surgery than in general surgery, as for maxillofacial conditions gut function is relatively rarely disrupted below stomach level. Generally, parenteral feeding is the fall-back feeding option and/or last resort if for some reason(s) enteral feeding is not possible. It is not the first non-oral feeding choice because parenteral feeding carries more risks than enteral tube feeding and is less suitable for long(er) term feeding outside a hospital setting because it essentially requires round-the-clock, slow drip operation.

Here we concentrate on enteral tube feeding. The following pages describe enteral feeding in more detail, both NG and PEG tube feeding. In the majority of cases tube feeding is a short- or medium-term intervention to help somebody through a period of difficulty, and oral food intake returns to some level of normality over time. We also briefly discuss practical aspects concerning long-term tube feeding and how to manage best at home.