Tracheomalacia after thyroidectomy for retrosternal goitres requiring sternotomy– a myth or reality?

Abstract

Introduction Tracheomalacia after thyroidectomy is not well understood. Reports on tracheomalacia are conflicting, with some suggesting a high rate and other large cohorts in which no tracheomalacia is reported. The aim of our study was to assess the incidence and factors associated with tracheomalacia after thyroidectomy in patients with retrosternal goitres requiring sternotomy at a high-volume tertiary care referral centre. Methods A longitudinal cohort study was conducted from January 2011 to December 2019. All adult patients who underwent thyroidectomy with sternotomy were included. Tracheomalacia was considered when tracheal rings were soft compared with other parts (proximal or distal) of the trachea and required either tracheostomy or resection with anastomosis. The decision to perform a tracheostomy or to administer continuous or bilevel positive airway pressure postoperatively was made depending on the degree of tracheomalacia. Logistic regression analysis was used to assess factors associated with tracheomalacia. Results We evaluated 40 patients who underwent thyroidectomy with sternotomy. The mean age of our cohort was 48.7 ± 11.3 years and the population was predominantly female (67.5%). One patient required tracheal resection with anastomosis, and two patients required tracheostomy. Multivariable logistic regression analysis did not reveal any patient- or thyroid-related factor significantly associated with the development of tracheomalacia in our cohort. Conclusions The incidence of tracheomalacia after thyroidectomy with sternotomy appears to be very low. However, the occurrence of tracheomalacia after thyroidectomy in cases of large goitre is possible and hence worrisome.

A critical update on the management of retrosternal goiter

“…Tracheomalacia remains the most dreadful complication in the case of large RGs, despite its incidence seems to be very low 92 . In a series of 40 patients subjected to thyroidectomy with sternotomy, tracheomalacia was reported in 3 cases, in absence of any patient-or thyroid-related factor significantly associated with its development: one patient required tracheal resection with anastomosis, and two patients required tracheostomy 92 .…”

“…Tracheomalacia remains the most dreadful complication in the case of large RGs, despite its incidence seems to be very low 92 . In a series of 40 patients subjected to thyroidectomy with sternotomy, tracheomalacia was reported in 3 cases, in absence of any patient-or thyroid-related factor significantly associated with its development: one patient required tracheal resection with anastomosis, and two patients required tracheostomy 92 . In another paper, 17 cases of tracheomalacia out of 106 cases were reported, probably caused by long-standing tracheal compression from RG: this study suggested that prolonged intubation was sufficient to resolve airways collapse without tracheal reconstruction in all cases 93 .…”

Surgical treatment of substernal goiter part 2: cervical and extracervical approaches, complications

“…When patients with SG are extubated, those who develop respiratory distress can generally be reintubated without a problem. [ 2 , 7 , 70 ] Tracheostomy can be considered in patients who have problems in reintubation and who continue to have respiratory distress. Agarwal et al suggested that it may contribute to the early healing of tracheomalacia by causing fibrosis in the soft tissue around the tracheostomy in patients with tracheomalacia.…”

“…In the treatment of tracheomalacia, besides intubation and tracheostomy, treatment alternatives such as surgical tracheopexy methods, tracheal stents, surgical external stabilization, and tracheal resection are recommended. [ 2 , 7 , 70 ]…”