CASE HISTORY

	Long standing goitre – 15yrs
	No history of airway obstruction or vocal cord palsy
	TFT normal
	X-Ray neck & CT neck – no compression & only slight Rt side deviation of trachea
	DL scopy – vocal cords normal
	Anaemic with mild cardiomegaly(Hb 9 gms%)

POST OPERATIVE  COMPLICATION

• Tracheomalacia – noted 3Hrs after surgery
• Intubated with 7 size ETT cuffed
• Large dose steroids given
• Trial extubation done with tube exchanger after 36Hrs.
• Patient went for stridor once again and re-intubated with 6 size ETT cuffed.
• Tracheotomy done after 2 Hrs.

DISCUSSION  OF POST OPERATIVE TRACHEOMALACIA

Incidence

• (Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, 226 014 Lucknow, India) - 1990–2005 - 28 patients treated for tracheomalacia
• Mean duration of thyroid enlargement -   13.75 years
• 7 patients had a history of stridor
• Tracheostomy was performed in 26 patients  18 patients on the operating table
• The tracheostomy tube was removed after an average of 8.5 days.

TAKE  HOME  MESSAGE
On the basis of our experience we strongly advocate tracheostomy intraoperatively if the trachea is soft and floppy and/or collapse of the trachea is observed following gradual withdrawal of the endotracheal tube over fibrioptic bronchoscopy.

Can we predict pre-operatively which patient will go for post thyroidectomy tracheomalacia? How to manage post thyroidectomy tracheomalacia?

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