A Theoretical Mechanism for Massive Supraglottic Swelling Following Carotid Endarterectomy

Abstract

Potentially life‐threatening massive supraglottic swelling is occasionally seen in patients presenting with neck swelling following carotid endarterectomy. This is considered to be a distinct clinical entity, and a theoretical mechanism based on a review of the relevant anatomy and physiology is postulated.

Airway Management in Patients Who Develop Neck Hematomas After Carotid Endarterectomy

“…Computed tomographic studies have shown that even in the absence of hematoma formation, post-CEA patients have increased airway edema that may decrease the transverse airway diameter by up to 75% (62% Ϯ 13%; mean Ϯ sd) compared with perioperative diameter. 15 This edema has been attributed to disruption of lymphatic drainage during the operative period 16 and results in swelling of the tracheal mucosa, supraglottic airway, glottic aperture, and the cricothyroid membrane. 15 The edema may thus complicate many airway management techniques including fiberoptic visualization, DL, and even surgical cricothyroidotomy.…”

Topical anaesthesia in patients with post‐thyroidectomy haemorrhage using the “spray‐as‐you‐go” technique

“…Successful tracheal intubation can be challenging in patients with a postoperative neck haematoma [3]. In addition, neck surgery disrupts lymphatic drainage, which can lead to swelling of the tracheal mucosa, supraglottic airway, glottic aperture and structures in the anterior part of the neck [4,5]. Airway oedema can complicate techniques such as direct laryngoscopy, transtracheal injection and surgical tracheostomy.…”

Airway Obstruction following Carotid Endarterectomy

“…Threedimensional reconstruction showed significant reduction in airway volume in all patients after carotid endarterectomy 5 . The aetiology of airway oedema after carotid endarterectomy may be secondary to soft tissue oedema due to surgical trauma, presence of neck haematoma and interference of venous and lymphatic drainage 6,7,9 . Previous thyroidectomy followed by irradiation predisposed our patient to postoperative airway oedema as lymphatic and venous drainage had been jeopardized 8 .…”