Airway Compromise in Thyroplasty Surgery

Abstract

Maragos, MD0-Vectives: Airway compromise arising from thyroplasty procedures including Isshiki type I through · IV thyroplasties, arytenoid adduction, and arytenoid fixation is uncommon yet potentially life threatening. Identification of incidence of obstruction and probable causes is important for preoperative planning, consultation, and postoperative care. Study Design: Retrospective review of all thyroplasty operations, including arytenoid adduction and arytenoid fixation. Methods: Three hundred thirty-two patients underwent a total of 630 thyroplasty procedures. Detailed information was gathered on patients manifesting symptoms of airway obstruction. Results: Seven patients required an unplanned tracheostomy for airway compromise. Five of 143 patients who underwent arytenoid adduction required a tracheostomy, for an incidence of3.5%. The median interval to developing significant stridor requiring tracheostomy was 9 hours, with five of these seven patients requiring airway surgery within the first 18 postoperative hours. No patient receiving a type I thyroplasty alone developed significant airway compromise. Tracheostomy was required in two patients with underlying n euromuscular disease-one who underwent a bilateral type I thyroplasty and one who underwent an arytenoid fixation procedure. Conclusion:The percentage of airway complications after thyroplasty is low. However, arytenoid adduction and fixation operations have a significant risk of postoperative temporary tracheostomy and warrant preoperative discussion regarding tracheostomy and postoperative overnight hospital admission.

Analyses of risk factors for postoperative airway compromise following arytenoid adduction

“…In the 51 patients who developed PAC in the present study, postoperative bleeding was a significant risk factor for severe PAC. In the report by Weinman and Maragos [7], 5 (3.5%) of the 143 patients who underwent AA required emergency tracheostomy. They noted that it was most probable that postoperative hematoma and edema were the principle causes of the airway complication and other possible causes include over-medialization anteriorly when combined with type 1 thyroplasty and over-rotation of the arytenoid cartilage.…”

Incidence of perioperative airway complications in patients with previous medialization thyroplasty

“…Complications arising immediately following the placement of the implant in MT procedures have been well studied and highlight the potential for airway compromise. Recent studies on type I thyroplasty have shown that rates of airway complications in the immediate postoperative period vary widely, with reports ranging from 0% to 10% 9–14. It is important to note however that many if not all MT procedures are done under local and intravenous sedative anesthesia and without endotracheal intubation, thereby sparing the vocal folds from the trauma of intubation and extubation.…”

Medialization Thyroplasty with a Customized Silicone Implant: Clinical Experience

“…However, the surgical adduction and fixation of the arytenoid cartilage has a significant risk of postoperative temporary tracheostomy [16] . In our study only 2 patients (5.6%) had complications after surgery and 2 other patients (5.6%) had no improvement of voice after surgery.…”