It sometimes happens: late tracheal rupture after total thyroidectomy

Abstract

Thyroidectomy is a safe procedure often performed either for benign or malignant thyroid diseases. Complication rate is low and tracheal injury associated with thyroidectomy is rarely described. The trachea may be perforated or lacerated intraoperatively; nevertheless, damage is usually recognized and directly repaired with reduced patient morbidity. We review a case of a 45-year-old male with a history of non-invasive thyroid cancer who underwent a total thyroidectomy with a tracheal necrosis and a subsequent rupture presenting 4 days following surgical operation. At home, while coughing, the patient experienced rapid swelling of neck, face and upper part of the chest. Computed tomography scan images demonstrated extensive subcutaneous emphysema and a defect in cervical trachea, confirmed also by bronchoscopy. The patient, without delay, underwent an exploration of the neck with a debridement of laceration. In view of the fact that a local infection was present, only a right pre-thyroid muscle flap was stitched on the defect. The patients recovered uneventfully.

Outcome of Capsular Dissection Using Monopolar Cautery in Thyroidectomy- A Retrospective Study

“…18 Risk factors associated with the tracheal injury occurring during or after thyroidectomy are female gender, benign thyroid diseases, prolonged intubation with high cuff pressure, toxic goiter, excessive use of cautery with increased blood loss intraoperatively, wound infection, tracheomalacia, and postoperative vigorous cough. 19 Capsular dissection technique, the technique of separating the diseased gland from the surrounding pseudocapsule (pre-tracheal fascia), by dissecting along the surface of the true capsule of the thyroid, will avoid important structures and will prevent complications. In this technique nerve is not exposed or traced.…”

What is the treatment of tracheal lesions associated with traditional thyroidectomy? Case report and systematic review

“…Equipment should be on hand for performing an emergent tracheostomy if necessary. Rapid sequence induction of anaesthesia and orotracheal intubation with placement of the cuff distal to the site of injury is usually sufficient to control the airway [ 13 ]. The management of delayed tracheal rupture after thyroidectomy should not differ from that of any other delayed tracheal injury.…”

“…Despite past assumptions that surgical treatment is indicated in all cases, recent studies have identified a subset of patients who could and should be managed conservatively [ 18 , 19 ]. If necessary, surgery must not be delayed [ 13 ]. Potential patient morbidity can include neck abscess, mediastinitis, pneumothorax, cardiac tamponade and tension pneumomediastinum.…”

“…The diagnosis of tracheal injury occurred between the 1st and 15th postoperative day [ 6 , 16 ]. In most of these patients, necrosis was found, and culture revealed bacterial infection in 3/15 patients by Beta-haemolytic Streptococcus [ 5 ], Streptococcus mitis [ 10 ] and Staphylococcus aureus [ 13 ]. The management depends on the authors and was very different among them.…”

Multiple Rare Complications Following Total Thyroidectomy and Bilateral Neck Dissection: Case Report and Literature Review

“…The injury might show itself during surgery or may undergo necrosis in the early postoperative period. Devascularization of the tracheal wall through thermal coagulation injury or necrosis of an ischemic area are the most likely causes [21][22][23]. Although the diagnosis is easy to make, yet the therapeutic approach remains debatable.…”