Interesting case

High Incidence of Tracheomalacia in Longstanding Goiters
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High Incidence of Tracheomalacia in Longstanding Goiters (A case report)

Dr.J.Edward Johnson M.D.

Longstanding Goiter (20 yrs )

CASE HISTORY

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

 

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X- RAY View
X- RAY NECK (AP view) X- RAY NECK (Lateral view)
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CT SCAN

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AIR WAY ASSESSMENT:
Mallampatti -class II
Anticipated difficult air way because of huge goitre almost occupying whole neck
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NO DIFFICULT INTUBATION (surprisingly)
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SIZE OF THE GLAND
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.

 

FAQCan we predict pre-operatively which patient will go for post thyroidectomy tracheomalacia? How to manage post thyroidectomy tracheomalacia?
See the answer in Ask the Expert page

 

 

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