1
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Song Z, Jiang Y, Tan J, Gu L, Cai J, Zhou Y. Conservative management of a rare case of post thyroidectomy tracheal injury with coagulation abnormalities. Heliyon 2024; 10:e28737. [PMID: 38586347 PMCID: PMC10998211 DOI: 10.1016/j.heliyon.2024.e28737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
Background Tracheal injury is a rare but potentially serious acute complication of endotracheal intubation. Very few cases of tracheal injury associated with coagulation abnormalities have been reported in the literature. We present a rare case of a patient presenting with tracheal injury in combination with coagulation abnormalities following thyroidectomy. Case presentation A 58-year-old woman with a history of postoperative chemotherapy for breast cancer, gastric polyps, multiple colonic polyps, esophageal papillary adenomas, and thyroid adenomas presented with dyspnea following 10 ml hemoptysis on the third day after thyroidectomy; she was admitted to the intensive care unit and underwent tracheal intubation for maintaining the airway. Subsequent bronchoscopy revealed a nodular red neoplasm 5-cm from the carina in the trachea obstructing part of the lumen, with a small amount of fresh hemorrhage on the surface. Tracheal injury was considered the preliminary diagnosis. Fiberoptic bronchoscope guided tracheal intubation helped prevent rupture of the tumor, and the cannula was properly inflated to arrest the bleeding while blocking the lower part of the trachea. An emergency surgical evacuation of the cervical hematoma was performed for managing postoperative bleeding. The patient demonstrated persistent pancytopenia despite frequent transfusions. Laboratory examination results revealed abnormal coagulation parameters, anemia, and hepatic dysfunction. Following a multidisciplinary team discussion, pituitrin for hemostasis, tranexamic acid for strengthening hemostasis treatment, and nutritional support and anti-infection treatment were initiated. Endotracheal tube cuff inflation was performed to compress the bleeding site. Complete resolution of the subcutaneous hematoma was observed nine days after the tracheal injury; bronchoscopy revealed residual ecchymosis in the airway hematoma with no evidence of obstruction. Conclusion Conservative management of tracheal injury limited to the mucosa or submucosa without significant amount of active bleeding using endotracheal intubation is considered a practical and effective approach. Successful management was ensured by appropriate clinical suspicion, early multidisciplinary team discussion, and prompt diagnosis and interventions.
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Affiliation(s)
- Zhenghuan Song
- Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, PR China
| | - Yueyi Jiang
- The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jing Tan
- Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, PR China
| | - Lianbing Gu
- Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, PR China
| | - Jiaqin Cai
- Xuzhou Medical University, Xuzhou, PR China
| | - Yihu Zhou
- The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, PR China
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2
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Misirovs R, Hoey G, Carruthers C, Majumdar S. Spontaneous tracheal perforation following a sneeze. BMJ Case Rep 2023; 16:e255633. [PMID: 38050389 PMCID: PMC10693861 DOI: 10.1136/bcr-2023-255633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Affiliation(s)
- Rasads Misirovs
- Scottish Centre For Respiratory Research, University of Dundee School of Medicine, Dundee, UK
- Doctoral Studies, Riga Stradins University, Riga, Latvia
| | - Gary Hoey
- Ninewells Hospital and Medical School, Dundee, UK
| | - Calum Carruthers
- Emergency Department, Ninewells Hospital and Medical School, Dundee, UK
| | - Samit Majumdar
- Otorhinolaryngology, Ninewells Hospital and Medical School, Dundee, UK
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3
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Chu JH, Sun JT, Sheng CW, Chang CJ, Chiang WC, Huang CY. A Woman With Neck Swelling and Dyspnea. Ann Emerg Med 2023; 82:e197-e198. [PMID: 37993231 DOI: 10.1016/j.annemergmed.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Jung-Hsien Chu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, Yilan, Taiwan
| | - Chong Wah Sheng
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Jung Chang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
| | - Chun-Yen Huang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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4
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Azar SS, Patel E, Evans LK, Blood TC, Su-Velez BM, Chhetri DK. Delayed Tracheal Perforation After Partial Thyroidectomy: A Case Report and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2023; 102:NP410-NP412. [PMID: 34030512 DOI: 10.1177/01455613211019785] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tracheal perforation is an extremely rare and potentially dangerous complication of a partial thyroidectomy. The current case represents a unique presentation of delayed tracheal perforation following an uncomplicated thyroid isthmusectomy for tissue diagnosis of an aggressive appearing thyroid mass in the setting of high-dose steroid administration and recent intubation and self-extubation. While conservative management of tracheal perforation can sometimes be appropriate, our patient was successfully managed via primary closure and infrahyoid muscle transposition flap to cover a 5 mm right lateral tracheal wall defect. We recommend caution be exercised following thyroid surgery in the setting of intubation and high-dose steroids.
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Affiliation(s)
- Shaghauyegh S Azar
- Department of Head and Neck Surgery, University of California Los Angeles, CA, USA
| | - Evan Patel
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauran K Evans
- Department of Head and Neck Surgery, University of California Los Angeles, CA, USA
| | - Timothy C Blood
- Department of Head and Neck Surgery, University of California Los Angeles, CA, USA
| | - Brooke M Su-Velez
- Department of Head and Neck Surgery, University of California Los Angeles, CA, USA
| | - Dinesh K Chhetri
- Department of Head and Neck Surgery, University of California Los Angeles, CA, USA
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5
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Long SM, Ali K, Tufano RP, Banuchi VE. Airway injury from transoral endoscopic thyroidectomy vestibular approach. Head Neck 2021; 44:E6-E10. [PMID: 34729859 DOI: 10.1002/hed.26909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/17/2021] [Accepted: 10/07/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel technique that eliminates a cervical scar. This procedure carries unique risks, and data on outcomes are needed as more cases are performed. METHODS We describe two cases of airway injury during the TOETVA. A description of the procedure and management of the injuries is outlined. RESULTS In one case, a 3-mm injury in the thyrohyoid membrane was identified. The TOETVA was converted to an open approach due to significant inflammation in the setting of Graves' and the repair was performed while open. In the second case, a fracture occurred from the thyroid notch to Broyle's ligament without avulsion. A primary repair was endoscopically performed. CONCLUSIONS Airway injury is a possible complication of both open thyroidectomy and TOETVA. For TOETVA, trauma is most likely to occur in the midline during Hegar dilation and trocar placement through the central incision.
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Affiliation(s)
- Sallie M Long
- Department of Otolaryngology - Head and Neck Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Khalid Ali
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ralph P Tufano
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Victoria E Banuchi
- Department of Otolaryngology - Head and Neck Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
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6
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Stevens MN, Bolduan A, Gelbard A. Delayed Tracheal Perforation Following Total Thyroidectomy. Laryngoscope 2021; 132:17-19. [PMID: 33782958 DOI: 10.1002/lary.29534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/07/2022]
Abstract
Delayed tracheal rupture following total thyroidectomy (TT) is rare and represents a potential airway emergency. A 34-year-old female with Felty Syndrome underwent TT for Hashimoto's thyroiditis. On post-operative day 10, she presented with subcutaneous emphysema and an anterolateral tracheal perforation on CT scan. Urgent operative exploration revealed transmural tracheal necrosis and a 5 mm perforation. This was oversewn with non-absorbable suture and a strap muscle flap rotated over the defect to promote healing. Repeat direct laryngoscopy at 72 hours revealed healing tissue. Tracheal necrosis and perforation following TT constitutes a potential airway emergency and should be promptly explored and repaired. Laryngoscope, 2021.
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Affiliation(s)
- Madelyn N Stevens
- Department Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Alyssa Bolduan
- Department Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Alexander Gelbard
- Department Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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7
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Cao XJ, Zhao ZL, Wei Y, Peng LL, Li Y, Wu J, Yu MA. Microwave ablation for papillary thyroid cancer located in the thyroid isthmus: a preliminary study. Int J Hyperthermia 2021; 38:114-119. [PMID: 33530750 DOI: 10.1080/02656736.2021.1880028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To assess the feasibility, efficacy, and safety of ultrasound (US)-guided microwave ablation (MWA) for the treatment of papillary thyroid cancer (PTC) located in the thyroid isthmus. MATERIALS AND METHODS Thirty-four patients (mean age, 43 ± 11 years; 26 women) with isthmic PTC treated with MWA between June 2014 and September 2020 were included in this retrospective study. The follow-up time after MWA was 17 ± 9 months (range, 8-50 months). Changes in thyroid function, parathyroid function, and tumor size were evaluated, along with the rates of tumor disappearance and complications. RESULTS The treatment was technically feasible and successfully completed in all 34 patients (100%). Measures of thyroid function (i.e. serum triiodothyronine, free thyroxine, and thyrotropin) and parathyroid function (i.e. serum calcium and intact parathyroid hormone) showed no changes from pretreatment levels at 1, 3, and 6 months after MWA (p > 0.05 for all). Tumor size was found to be increased at 1 and 3 months after MWA compared with before MWA (p < 0.05). However, the tumor sizes measured at 6, 9, 12, and 18 months after MWA were smaller than the pretreatment sizes (p < 0.05 for all). In 24 cases (70.6%), the tumors completely disappeared on US examination. Five cases (2.9%) experienced side effects from MWA treatment, but no major or minor complications were recorded. CONCLUSION The results of this study demonstrate that US-guided MWA is a feasible, effective, and safe treatment option for selected patients with PTC located in the thyroid isthmus.
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Affiliation(s)
- Xiao-Jing Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
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8
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Shew M, Boyd C, Kraft S. Delayed Multifocal Tracheal Injury Following Thyroidectomy: A Case Report and Review of the Literature. Cureus 2020; 12:e8164. [PMID: 32550080 PMCID: PMC7296883 DOI: 10.7759/cureus.8164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Delayed presentation of tracheal injury after thyroidectomy is a rare complication. We present the case of a 24-year-old male presenting with findings of tracheal injury 12 days after total thyroidectomy. Upon surgical exploration, multifocal, transmural tracheal injuries were identified. Repair was performed with a combination of acellular dermal matrix allograft, local-regional flaps, silicone stenting, and tracheostomy. Herein we also review published cases of delayed tracheal injury. Our findings suggest that delayed tracheal necrosis and rupture is an uncommon yet potentially devastating complication of thyroidectomy. Surgeons should maintain a low threshold to suspect such injuries when patients present with neck swelling and subcutaneous emphysema, even up to 40 days post-operatively. Complex injuries may require a multidisciplinary approach and an armamentarium of reconstructive techniques.
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Affiliation(s)
- Matthew Shew
- Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, USA
| | - Christopher Boyd
- Otolaryngology - Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, USA
| | - Shannon Kraft
- Otolaryngology - Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, USA
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9
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Sia Y, Fleming B. Subcutaneous cervicofacial emphysema following thyroid surgery. ANZ J Surg 2020; 90:2584-2586. [PMID: 32402147 DOI: 10.1111/ans.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Yi Sia
- Endocrine Surgery Unit, Department of Surgery, Footscray Hospital, Melbourne, Victoria, Australia
| | - Bill Fleming
- Endocrine Surgery Unit, Department of Surgery, Footscray Hospital, Melbourne, Victoria, Australia
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10
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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11
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Grewal HS, Dangayach NS, Ahmad U, Ghosh S, Gildea T, Mehta AC. Treatment of Tracheobronchial Injuries: A Contemporary Review. Chest 2018; 155:595-604. [PMID: 30059680 DOI: 10.1016/j.chest.2018.07.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/26/2018] [Accepted: 07/13/2018] [Indexed: 12/26/2022] Open
Abstract
Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and iatrogenic injury that might occur during surgery, endotracheal intubation, or bronchoscopy. Early recognition of clinical signs and symptoms can help risk-stratify patients and guide management. In recent years, there has been a paradigm shift in the management of tracheal injury towards minimally invasive modalities, such as endobronchial stent placement. Although there are still some definitive indications for surgery, selected patients who meet traditional surgical criteria as well as those patients who were deemed to be poor surgical candidates can now be managed successfully using minimally invasive techniques. This paradigm shift from surgical to nonsurgical management is promising and should be considered prior to making final management decisions.
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Affiliation(s)
| | - Neha S Dangayach
- Neurocritical Care Division, Mount Sinai Health System, New York, NY
| | - Usman Ahmad
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH
| | - Subha Ghosh
- Radiology Institute, Cleveland Clinic, Cleveland, OH
| | - Thomas Gildea
- Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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12
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Windon MJ, Dhillon V, Tufano RP. Case report: presentation of delayed tracheal perforation after hemithyroidectomy. AME Case Rep 2018; 2:24. [PMID: 30264020 DOI: 10.21037/acr.2018.05.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/08/2018] [Indexed: 11/06/2022]
Abstract
Hemithyroidectomy is a low-risk, outpatient procedure commonly performed for benign and some small, differentiated thyroid malignancies. Delayed tracheal perforation following thyroid surgery is exceedingly rare and has previously only been reported after total thyroidectomy. We describe a 25-year-old patient who underwent an unremarkable right hemithyroidectomy to remove a 4-centimeter fine needle aspiration cytologically indeterminate thyroid nodule, and presented 4 weeks later with acute anterior neck swelling and subcutaneous emphysema after strenuous exercise. Computed tomography showed pockets of air tracking along a right lateral tracheal wall irregularity on the operative side. Flexible tracheobronchoscopy identified a corresponding pinhole-sized defect. A bedside neck exploration was performed with drain placement. The patient was restricted to limited activity for 4 weeks, and recovered uneventfully. Surgeons who perform thyroid surgery must be aware of the possibility of delayed tracheal perforation after hemithyroidectomy. Conservative management may be appropriate for the stable patient.
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Affiliation(s)
- Melina J Windon
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vaninder Dhillon
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Tartaglia N, Iadarola R, Di Lascia A, Cianci P, Fersini A, Ambrosi A. What is the treatment of tracheal lesions associated with traditional thyroidectomy? Case report and systematic review. World J Emerg Surg 2018; 13:15. [PMID: 29588652 PMCID: PMC5865337 DOI: 10.1186/s13017-018-0175-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/06/2018] [Indexed: 02/08/2023] Open
Abstract
Aim The aim of this study is to review the literature focusing on various treatments based on time of tracheal injury and on different surgeons' personal experience. Methods We retrospectively reviewed all cases of total thyroidectomy performed at the University Surgical Department of Ospedali Riuniti of Foggia from 2006 to 2017. Only a single case of tracheal lesion due to traditional total thyroidectomy was found. An extensive search of the relevant literature was carried out using MEDLINE (PubMed). We included articles that reported article type, patient number, sex, age, reasons for surgery, time of tracheal perforation intraoperatively or delayed rupture, symptoms, diagnosis, type of surgical procedure, pathological report and follow-up. Results A total of 156 published studies were screened from the sources listed. Of these, 15 studies were included in the present study. We introduced our case in the analysis. A total of 16 patients were totally analysed. There were seven males (43.7%) and seven females (43.7%), and for two patients, gender was not available. The mean patient age was 41.6 years. Conclusions The literature review showed very few cases treated differently. However, it would be good to standardise treatments. Tracheal perforation, if encountered, needs to be managed appropriately in centres of expertise with a high volume of thyroidectomies.
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Affiliation(s)
- Nicola Tartaglia
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
| | - Roberta Iadarola
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
| | - Alessandra Di Lascia
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
| | - Pasquale Cianci
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
| | - Alberto Fersini
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
| | - Antonio Ambrosi
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
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14
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Pneumomediastinum and Bilateral Pneumothoraces Causing Respiratory Failure after Thyroid Surgery. Case Rep Anesthesiol 2017; 2017:8206970. [PMID: 28523194 PMCID: PMC5421092 DOI: 10.1155/2017/8206970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 04/18/2017] [Indexed: 11/17/2022] Open
Abstract
We report the first case of severe respiratory failure after thyroid surgery requiring venovenous extracorporeal membrane oxygenation (vvECMO). The patient was a 41-year-old woman with metastatic thyroid cancer. She underwent thyroidectomy, including left lateral and bilateral central neck dissection. During surgery, the patient developed pneumomediastinum with bilateral pneumothoraces. Despite early treatment with bilateral chest tubes and no evidence of a tracheal perforation, the patient developed severe respiratory failure after extubation on the intensive care unit. Because pneumothorax and pneumomediastinum might be more common than reported, and considering increasing cases of thyroid surgery, staff should remain vigilant of pulmonary complications after thyroid surgery.
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15
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Escott AB, Pochin RS. Repair of a posterior perforation of the trachea following thyroidectomy with a muscle transposition flap. EAR, NOSE & THROAT JOURNAL 2017; 95:E14-7. [PMID: 26930337 DOI: 10.1177/014556131609500205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Tracheal perforation is a rare postoperative complication of total thyroidectomy. While previously documented cases have been reported in the anterior aspect of the trachea after a total thyroidectomy, we report what we believe is the first documented case of a perforation in the posterior aspect of the trachea. Our patient was a 29-year-old woman who presented with symptoms of tracheal impingement in the context of a right-sided goiter that subsequent investigation found to be three benign colloid nodules. Fourteen days after her total thyroidectomy, she presented with surgical emphysema surrounding the wound. Computed tomography identified a 2.5-mm defect in the right posterior lateral trachea, posterior to the cartilaginous ring. The defect failed to seal spontaneously, and after 48 hours, the patient remained symptomatic. During reexploration, the defect was successfully repaired with a myovascular transposition flap in conjunction with Tisseel tissue-bonding agent. This technique has the potential to be applied in future intraoperative and postoperative cases of tracheal perforation.
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Affiliation(s)
- Alistair B Escott
- Corresponding author: Dr. Alistair B.J. Escott, Department of Surgery, The University of Auckland, Level 11, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland 1010, New Zealand. From the Department of Surgery, The University of Auckland, Auckland, New Zealand (Dr. Escott); and the Department of Surgery, Nelson Hospital, Nelson, New Zealand (Mrs. Pochin). The case described in this article occurred at Nelson Hospital
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16
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Kumar S, Kaushal A, Shamim R. Delayed tracheal perforation, a rare but dreaded complication of thyroidectomy. Saudi J Anaesth 2017; 11:351-352. [PMID: 28757841 PMCID: PMC5516503 DOI: 10.4103/sja.sja_637_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sanjay Kumar
- Department of Anaesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kaushal
- Department of Neuroanaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rafat Shamim
- Department of Anaesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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18
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Peng H, Wang SJ, Li W. Rare complication after thyroidectomy-cervical esophageal stenosis: a case report and literature review. World J Surg Oncol 2014; 12:308. [PMID: 25305782 PMCID: PMC4210506 DOI: 10.1186/1477-7819-12-308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 10/03/2014] [Indexed: 02/05/2023] Open
Abstract
The most common complications after thyroidectomy are injuries associated with the recurrent laryngeal nerve and parathyroid gland. Cervical esophagus perforation is an exceptionally rare complication after thyroidectomy; it can usually be resolved by conservative care. Cervical esophageal stenosis secondary to intraoperative esophageal injury during thyroidectomy is much rarer and has not been reported in the literature to date. We report a case of esophageal stenosis following thyroidectomy performed at a peripheral hospital. The patient initially underwent a thyroidectomy for papillary thyroid carcinoma involving the cervical esophagus; esophageal perforation was noted intraoperatively, and closed using three number 4 silk sutures. Cervical esophageal stenosis subsequently developed after conservative care. The patient was successfully treated with cervical esophagectomy and reconstruction using a tubed forearm free flap after a failed attempt at endoscopic recanalization. This case is discussed in conjunction with a review of the literature.
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Affiliation(s)
- Hanwei Peng
- />Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou City, Guangdong Province 515031 China
| | - Steven J Wang
- />Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post St, 3rd Floor, San Francisco, CA 94115 USA
| | - Weixiong Li
- />Department of Head and Neck Surgery, Chaozhou People’s Hospital, Chaozhou City, Guangdong Province 521011 China
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19
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Materazzi G, Fregoli L, Ribechini A, Miccoli P. Conservative management of a tracheal leakage occurring 40 days after robotic thyroidectomy. Otolaryngol Head Neck Surg 2013; 149:793-4. [PMID: 23975716 DOI: 10.1177/0194599813501781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Mazeh H, Suwanabol PA, Schneider DF, Sippel RS. Late manifestation of tracheal rupture after thyroidectomy: case report and literature review. Endocr Pract 2012; 18:e73-6. [PMID: 22297061 DOI: 10.4158/ep11344.cr] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report an extremely rare case of delayed tracheal rupture after thyroidectomy and to review the existing related literature. METHODS We present the history, clinical findings, radiographic evaluation, management, and intraoperative findings in a patient who presented with subcutaneous emphysema 9 days after total thyroidectomy. In addition, we review the literature and discuss the diagnostic challenges as well as management options. RESULTS A 17-year-old female patient underwent a total thyroidectomy for Graves disease. On postoperative day 9, the patient presented with face and neck swelling attributable to subcutaneous emphysema. After conservative management failed, the patient underwent surgical exploration of the neck, which revealed a 2.5-cm linear vertical tear in the anterior aspect of the trachea, with no evidence of necrosis. The tear had viable edges and was primarily repaired with use of muscle flap reinforcement. The patient recovered with no other complications. CONCLUSION Delayed tracheal rupture should be suspected in all patients who present with subcutaneous emphysema after a thyroid surgical procedure. Review of the pertinent literature suggests that conservative management is suitable in patients with a stable condition. Surgical repair is indicated in those patients who fail to demonstrate clinical improvement.
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Affiliation(s)
- Hagig Mazeh
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA
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21
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Bertolaccini L, Lauro C, Priotto R, Terzi A. It sometimes happens: late tracheal rupture after total thyroidectomy. Interact Cardiovasc Thorac Surg 2012; 14:500-1. [PMID: 22232232 PMCID: PMC3309815 DOI: 10.1093/icvts/ivr126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/16/2011] [Accepted: 11/21/2011] [Indexed: 11/12/2022] Open
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.
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Affiliation(s)
- Luca Bertolaccini
- Thoracic Surgery Unit, S. Croce e Carle City Hospital, Cuneo, Italy.
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22
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Heavrin BS, Hampson S, Stack LB. Tracheal perforation after thyroidectomy. J Emerg Med 2011; 43:e259-60. [PMID: 21550755 DOI: 10.1016/j.jemermed.2011.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 09/24/2010] [Accepted: 03/20/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Benjamin S Heavrin
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4700, USA
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23
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Tartaglia F, Russo G, Manciati P, Blasi S, Sgueglia M. Iatrogenic Lesion of the Larynx during Total Thyroidectomy: A Rare Complication. Am Surg 2011. [DOI: 10.1177/000313481107700304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Giulia Russo
- Surgical Sciences Department Sapienza University of Rome Rome, Italy
| | - Paola Manciati
- Department of Otorhinolaryngology, Audiology and Phoniatrics Sapienza University of Rome Rome, Italy
| | - Sara Blasi
- Surgical Sciences Department Sapienza University of Rome Rome, Italy
| | - Monica Sgueglia
- Surgical Sciences Department Sapienza University of Rome Rome, Italy
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24
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Lee HC, Yun MJ, Goo EK, Bahk JH, Park HP, Jeon YT, Lee SC. Rupture of endotracheal tube cuff during robot-assisted endoscopic thyroidectomy -A case report-. Korean J Anesthesiol 2010; 59:416-9. [PMID: 21253380 PMCID: PMC3022136 DOI: 10.4097/kjae.2010.59.6.416] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/19/2010] [Accepted: 03/24/2010] [Indexed: 11/17/2022] Open
Abstract
We encountered a case of a rupture of an endotracheal tube cuff during robot-assisted thyroid surgery in a 35-year-old male patient. Two hours after commencing surgery, the bellows of the ventilator were not filled and a rupture of the endotracheal tube cuff was suspected. Once the robot-manipulator is engaged, the position of the operating table cannot be altered without removing it from the patient. Reintubation with direct laryngoscopy was performed with difficulty in the narrow space between the patient's head and robot-manipulator without moving the robot away from the patient. The rupture of the endotracheal tube cuff was confirmed by observing air bubbles exiting from the balloon in water. The patient was discharged 3 days after surgery without complications. In robot-assisted thyroid surgery, a preoperative arrangement of the robot away from the patient's head to obtain easy access to the patient is essential for safe anesthetic care.
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Affiliation(s)
- Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Mi-Ja Yun
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Eui-Kyoung Goo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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25
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Damrose EJ, Damrose JF. Delayed tracheal rupture following thyroidectomy. Auris Nasus Larynx 2008; 36:113-5. [PMID: 18487029 DOI: 10.1016/j.anl.2008.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2007] [Revised: 02/12/2008] [Accepted: 03/14/2008] [Indexed: 02/07/2023]
Abstract
Thyroidectomy is a commonly performed, low-risk procedure. Tracheal perforation during thyroidectomy is rare, and delayed rupture of the trachea rarer still. We present the case of a patient who underwent total thyroidectomy secondary to Grave's disease who, on postoperative day 7, developed massive subcutaneous emphysema and respiratory distress. Surgical exploration revealed a rupture of the anterolateral tracheal wall at the level of the first tracheal ring. The defect was repaired primarily and the patient recovered uneventfully. The risk factors for and the management of this rare complication are discussed.
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Affiliation(s)
- Edward J Damrose
- Department of Otolaryngology/Head & Neck Surgery, Stanford University Medical Center, 801 Welch Road, Stanford, CA 94305, USA.
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Bilateral pneumothorax and pneumomediastinum following total thyroidectomy with central neck dissection. Clin Exp Otorhinolaryngol 2008; 1:49-51. [PMID: 19434263 PMCID: PMC2671755 DOI: 10.3342/ceo.2008.1.1.49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 10/25/2007] [Indexed: 11/29/2022] Open
Abstract
We describe a 60-year-old woman who developed extensive emphysema, bilateral pneumothorax, and pneumomediastinum after total thyroidectomy and central neck dissection with sacrifice of a recurrent laryngeal nerve. In this report, we discuss the possisle etiology of those rare complications.
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