This condition is secondary to longstanding extrinsic tracheal compression with subsequent loss of tracheal cartilage rigidity, culminating in dynamic airway collapse in excess of 50% of diameter.1 It is commonly suggested in anaesthetic practice and training that removal of the compressive source (i.e. Intervention: Urgent evacuation of the hemato-ma was done under general anaesthesia & bleeders were re-ligated. For this condition, temporary tracheostomy need to be done for 2 … Epub 2011 Jun 16. Between January 2008 and July 2010, a total of 334 patients (265 females, 69 males) underwent thyroid surgery. In addition to providing greater power, larger (and therefore most likely multicentre) prospective studies would be able to examine any such putative factors. Vocal cord issues - The recurrent laryngeal nerve (which helps control your voice) runs very close to the thyroid gland and may be accidentally damaged during thyroid surgery. The neglected goiter is still a problem in our environment and in some endemic areas; the enlarged glands reach enormous sizes before the patient … This LOS is longer than the average for our unit (1.1 days) but similar to the national average LOS for thyroidectomy reported by the third national British Association of Endocrine and Thyroid Surgeons’ audit (2.7 days).8. Background:Some thyroid anaplastic carcinoma and lymphoma have been reported to cause tracheal stenosis or choking. Furthermore, there is disparity in its reported incidence in the literature, which ranges from as low as 0% to as high as 10%.2. thyroidectomy) may precipitate life-threatening airway collapse (particularly during expiration) and potentially mandate emergency tracheostomy.1 However, anecdotal evidence from surgeons with extensive experience suggests that this is almost never encountered. 2006 Dec;120(12):1038-41. doi: 10.1017/S0022215106003045. This supports prior work on retrosternal goitres suggesting that the risk of tracheomalacia is minimal in modern thyroid surgery. Consequently, tracheomalacia may present unheralded as an emergency after thyroidectomy; hence historically, it has been feared as a complication of thyroidectomy. Examples of postoperative tracheomalacia in patients with neglected goiters endemic in the third world or recurrent goiter with airway compromise in a western medical center referral practice are described … Thyroidectomy in patients with marked thyroid enlargement: airway management, morbidity, and outcome. Thyroid operations (thyroidectomy) are used for patients who have a variety of thyroid conditions, including bot… The perioperative morbidity in our series was in keeping with current surgical standards, and while length of hospital stay was greater in those with tracheal compression than our unit's average, it was less than the current UK national average. Critical compression <5 mm was observed in 18 patients (6%) and 35 patients had compression to 6–10 mm. Preoperative CT scan was performed in 101 patients (30.2%) based on clinical suspicion of airway compression (n=58, 17.4%), retrosternal extension (n=48, 14.4%), or for staging of known malignant tumours (n=16, 4.8%). accurately predicting the risk of PTTM and respiratory complications in order to manage operative risk. Whenever possible, thyroid surgery should be performed by an experienced, high-volume surgeon to minimize complications. † In this series of 334 patients, 62 had tracheal compression. Critical tracheal compression to a diameter <5 mm was seen in 18 patients (5.4%) with benign (n=16) and malignant goitres (n=2). 16. For Permissions, please email: journals.permissions@oup.com, http://www.baets.org.uk/Pages/BAETS%203rd%20National%20Audit.pdf, Copyright © 2021 The British Journal of Anaesthesia Ltd. The tracheal tube used was size 6 (n=7), 6.5 (n=4), 7 (n=33), 7.5 (n=10), and 8 (n=8). induction, bag-mask ventilation, and intubation were performed otherwise (n=53) and no difficulty was encountered. Int J Surg 19(2):432–437. There were no admissions to the intensive care unit. tomy hematoma in an elective surgery done for a large thyroid. Bethesda, MD 20894, Copyright 2 pints of A+ blood was transfused. Would you like email updates of new search results? Standard intubation was performed otherwise. Privacy, Help Tracheomalacia is a feared complication of goitre surgery, but considered rare in the Western World. A retrospective review was conducted of all patients who underwent thyroid surgery in our UK university tertiary referral centre over a 30 month period. Prevention and treatment information (HHS). Awake fibreoptic intubation was performed in eight patients (of whom six had tracheas <5 mm) because they experienced worsening dyspnoea on lying flat. Constriction of the upper airway by the growing goiter may be indication for operation, but the residual problem of tracheomalacia after thyroidectomy is a life-threatening postoperative complication. One patient suffered a recurrent laryngeal nerve palsy (sacrificed to allow goitre excision). This rarely documented problem occurs following surgery for large and long-standing goitres, primary tracheal resections, oesophagectomy and postoperative airway infection. Dralle H, Sekulla C, Lorenz K, Grond S, Irmscher B. Chirurg. thyroidectomy tracheomalacia is rare,1,2 while its very existence in the developed world is questioned.3-5 In this case report, we discuss the recognition and management of a patient with symptomatic tracheal compression and document supraglottic, glottic, subglottic, and intrathoracic airway obstruction following a total thyroidectomy. Adult-acquired tracheomalacia is most commonly post-traumatic due to prolonged or recurrent intubation, tracheal fractures, or chronic inflammation such as chronic obstructive pulmonary disease.10,11 Extrinsic compression by bronchogenic carcinoma, aortic aneurysm, and goitres may also be causative.12 Although definitive criteria are lacking, a cut-off of a 50% reduction in tracheal lumen is usually considered a prerequisite for diagnosis.2 This relies largely on dynamic imaging, either CT or MRI.13,14 However, in patients with extrinsic compression such as those due to goitre, tracheomalacia may theoretically only become apparent following removal of their compressive agent. Case presentation: We experienced a huge adenomatous goiter (resected specimen weight: 520g). In his book entitled The History of Endocrine Surgery, Richard Welbourn details the beginnings of thyroidectomy.99 Goitres were recognized in antiquity and were described in Chinese literature in 2700 bc. Incidence is 3-5%. High incidence of tracheomalacia in longstanding goiters: experience from an endemic goiter region. One patient, for whom staged tracheoplasty was planned, opted for tracheostomy, whereas four patients have had adequate tracheal airways restored by extrinsic support. Two patients presented with stridor and underwent urgent operations. CONCLUSIONS: Esophageal stenting can be used to prevent mediastinal leakage due to esophageal injury in the transsternal approach for high thoracic vertebral metastasis, but the stent might be a cause of tracheomalacia. This study aimed to estimate the risk of tracheomalacia in a contemporary series of patients with goitres causing significant tracheal compression. Confidence intervals for zero numerators were generated with Hanley and Lippman-Hand's method.7 As this was a retrospective review of current clinical practice, ethical approval was not required. All but two patients had an elective operation at a mean (sd) of 18 (16) weeks after the CT scan. Chronic complications include hypothyroidism (which is the expected result of most thyroid surgery) and hypoparathyroidism. However, more highly powered (and ideally prospective) studies are necessary. This patient received surgical repair and recovered uneventfully. 2004 Feb;75(2):131-43. doi: 10.1007/s00104-003-0775-7. Tracheomalacia is a process characterized by flaccidity of the supporting tracheal cartilage, widening of the posterior membranous wall, and reduced anterior-posterior airway caliber. Those with tracheal compression (defined as a reduction in the size of the tracheal lumen to <15 mm, as identified on cross-sectional imaging) were selected. World J Surg. Although it is implied that a number had tracheal distortion (either compression or displacement), the number of patients within this subgroup was not published. Aim: Tracheomalacia is a potentially life-threatening, but a rare complication of thyroidectomy. the risk of type II error) would be 0.96962: 0.142 or 14.2%.7 Despite this, our study represents the largest series to specifically assess and quantify goitres causing major degrees of tracheal compression, a group historically considered to be at high risk of PTTM. Accessibility Tracheal compression to a minimum of 6–10 mm was observed in a further 35 patients. National Library of Medicine One was treated by subtotal thyroidectomy with tracheal suspension; one by staged thyroid reductions; two were treated by creation of extrinsic tracheal neo-rings constructed of surgical wire and vascular prostheses. Although some have investigated the impact of tracheal compression on respiratory complications, no studies have attempted to correlate this variable with risk of PTTM or stratify its severity. A number of other studies have included patients with significant tracheal compression, although again this was not quantified or stratified. However, for some, surgery may be required in order to safeguard the windpipe. A second patient was also supported by the prosthetic rings but extruded one of them, possibly because of tracheostomy contamination. Tracheal involvement occurs in about one-third of these patients. Morbidity in this cohort of patients was similar to that observed in patients without tracheal compression. Our study suggests that the risk of PTTM is indeed minimal within modern thyroid surgery, and furthermore that thyroidectomy can be performed safely on patients with critical degrees of tracheal compression. Anaesthetic, operative, radiological, and pathological data were obtained from medical notes and hospital software systems. Of 334 patients who underwent thyroid surgery, preoperative CT scan was performed in 101 (30%). This condition is secondary to longstanding extrinsic tracheal compression with subsequent loss of tracheal cartilage rigidity, culminating in dynamic airway collapse in excess of 50% of diameter.1 We found zero incidence of PTTM (95% CI 0.0–4.8%), including in those with critical tracheal compression. Indications for thyroidectomy include multinodular goiter, thyroid cancer, Graves’ disease and thyroiditis. Total thyroidectomy resolved the dyspnea Of 24 patients, 20 had some degree of tracheal compression; none developed PTTM, and the presence of tracheal compression did not increase the need for sternotomy. Agarwal A, Mishra AK, Gupta SK, Arshad F, Agarwal A, Tripathi M, Singh PK. Careers. The most likely cause of tracheal injury is massive overinflation of the endotrache... Tracheal rupture related to endotracheal intubation after thyroid surgery: a case report and systematic review - Xu - 2016 - International Wound Journal - Wiley Online Library Furthermore, no studies have attempted to stratify the risk of PTTM in patients with differing degrees of tracheal compression. Demographic characteristics including the age and sex of patients who underwent thyroidectomy between 2007 and 2017 and also the incidence of tracheomalacia after surgery were recorded. Extubation is then performed 24 to 48 hours later under controlled conditions. The pathophysiology of acquired adult tracheomalacia has yet to be conclusively elucidated. All patients were recovered on a general surgical ward. Background. 2011 Sep;35(9):1977-83. doi: 10.1007/s00268-011-1178-4. 1) Hypocalcemia. Two hundred and eight studies that reported cases or case series were selected for analysis. In this series of 334 patients, 62 had tracheal compression. The reasons underlying this are unclear. If such obstruction occurs, the patient should be reintubated. One patient developed postoperative hypocalcaemia. Epub 2008 May 31. The myth of tracheomalacia and difficult intubation in cases of retrosternal goitre. Constriction of the upper airway by the growing goiter may be indication for operation, but the residual problem of tracheomalacia after thyroidectomy is a life-threatening postoperative complication. onclusion: Post-thyroidectomy hematoma Surgery remains the main modality of treatment for thyroid cancer patients with tracheal involvement, the goal being complete resection with negative margins. This can cause the tracheal wall to collapse and block the airway, making it hard to breathe. One patient developed a seroma and another a minor wound haematoma; neither mandated airway intervention. Awake fibreoptic intubation was performed in eight patients (six of those with tracheas <5 mm) and asleep fibreoptic intubation was performed in one. Tracheomalacia may be misdiagnosed as asthma or noisy breathing known as stridor. We found no evidence of tracheomalacia in high-risk patients with significant tracheal compression. Consequently, the availability of these subgroups for study is limited, and may make interpreting the clinical significance of zero incidences difficult. Standard i.v. Following surgery, you may experience: Voice changes, such as, a hoarse voice, difficulty in speaking loudly, voice fatigue, and a change in the tone of your voice. This study explored the risk of PTTM in patients with tracheal compression and aimed to stratify and quantify the underlying degree of tracheal compression. 2017 Nov;6(6):307-314. doi: 10.1159/000480348. Tracheomalacia can occur after goitre surgery, but its reported incidence varies. Tracheomalacia is a very rare post-thyroidectomy complication. J. M. Findlay, G. P. Sadler, H. Bridge, R. Mihai, Post-thyroidectomy tracheomalacia: minimal risk despite significant tracheal compression, BJA: British Journal of Anaesthesia, Volume 106, Issue 6, June 2011, Pages 903–906, https://doi.org/10.1093/bja/aer062. Most recently, in 2007, Agarwal and colleagues3 found an incidence of PTTM in 28 of 900 thyroidectomies (3.1%). Oxford University Press is a department of the University of Oxford. Interpreting zero numerators, The British Association of Endocrine and Thyroid Surgeons, Ueber ein pulsiondivertikel der trachea mit bemerkungen uber das verhalten der elastichen fasern an normalen tracheen und bronchein [in German], Acquired tracheomalacia: etiology and differential diagnosis, Airway stabilization with silicone stents for treating adult tracheobronchomalacia: a prospective observational study, Syphilitic aortic aneurysm: a rare case of tracheomalacia, Acquired tracheomalacia: detection by expiratory CT scan, Evaluation of tracheal collapsability in patients with dynamic MR imaging during coughing, The myth of tracheomalacia and difficult intubation in cases of retrosternal goitre, Thyroidectomy is safe and effective for retrosternal goitre, The surgical approach to retrosternal goiters: the role of computerized tomography, Surgical management of substernal goiters: clinical experience of 170 cases, A case of diffuse panbronchiolitis associated with tracheomalacia, © The Author [2011]. The endoscopic examination at 3 months after stent removal showed complete healing of the esophagus. Begin thyroid tumors with dyspnea due to tracheal stenosis are exceedingly rare. 3 - 5 In this case report, we discuss the recognition and management of a patient with symptomatic tracheal compression and document supraglottic, glottic, subglottic, and intrathoracic airway obstruction following … This may last a few days or a few weeks but is rarely permanent. Congenital tracheomalacia often goes away as the infant grows and the walls of the trachea get stronger. All rights reserved. Until tracheal replacement or better tolerated prosthetic or biologic supports are devised, tracheomalacia will remain a vexing problem complicating thyroidectomy for long-standing or recurrent airway-compressing goiter. One of the most common disorders of endocrine glands requiring surgical intervention is goiter. The authors were able to identify a duration of goitre for more than 5 yr, the presence of radiological deviation/compression of the trachea, retrosternal extension, and difficulty in intubation to be risk factors for tracheostomy (rather than PTTM). J Laryngol Otol. However cosmesis is the most common indication generally [2]. In a retrospective analysis in 2004, Shen and colleagues5 identified 60 patients with retrosternal goitre. The aim of this study was to assess the incidence of tracheomalacia in patients with significant tracheal compression who were operated on in a UK tertiary referral centre for thyroid surgery. [Ambulatory and brief inpatient thyroid gland and parathyroid gland surgery]. 2004 Oct;118(10):778-80. doi: 10.1258/0022215042450751. One patient was readmitted on the third postoperative day with a progressive neck collection/abscess. Bennett AM, Hashmi SM, Premachandra DJ, Wright MM. We also focus on a case of tracheal laceration after tracheal intubation in a patient with severe thyroid carcinoma. Thyroidectomy is the most common treatment for goiter presently in Nigeria [1]. Please enable it to take advantage of the complete set of features! 8600 Rockville Pike Examples of postoperative tracheomalacia in patients with neglected goiters endemic in the third world or recurrent goiter with airway compromise in a western medical center referral practice are described for development of management methods. In the largest single study reported to date (a retrospective analysis of 199 thyroidectomies for retrosternal goitre), 118 were found to have a degree of tracheal compression.16 PTTM was reported in two patients (1.0% overall), although whether either had tracheal compression was not stated. However, were we to assume an incidence of 3.1% as suggested by Agarwal and colleagues in the largest series of at-risk patients to date, the probability of PTTM not occurring individually would be equal to 0.969. The Surgical Affairs Committee of the American Thyroid Association convened a writing group to focus on the optimal surgical management of goiter. Ultimately, these studies would aim to translate this into clinical relevance; i.e. Tracheomalacia may result from prolonged compression by expanding goiter, particularly within the confines of the thoracic inlet. Results: From 2007 to 2017, total 1236 thyroidectomy were performed. None required tracheostomy or tracheal stenting. Future studies may also be able to examine and quantify more complicated structural data, for example, incorporating the length, location, degree of deviation, and resultant cross-section and morphology into the stratification of tracheal compression. There have been few prospective trials, and studies have varied greatly as regards methodology and study population. All patients were recovered on a general surgical ward, with the exception of those undergoing sternotomy (n=4) who were recovered overnight on the Cardiothoracic Critical Care Unit before transfer to a general surgical ward. For the purposes of this statement article, goiter will be defined as benign enlargement of the thyroid gland; toxic nodular goiter and thyroid carcinoma are beyo… Epub 2006 Sep 25. No patients developed any immediate respiratory difficulties, none required tracheal stenting, and none had evidence of postoperative tracheomalacia [95% confidence interval (CI) 0.04–0.8%]. † Tracheomalacia after thyroid surgery is rare in contemporary UK practice. doi: 10.1016/s1052-3359(03)00036-x. Pho- This surgery opens up the trachea by moving up the aorta (the body's main blood vessel) and attaching it to the back of the breastbone (sternum). Clipboard, Search History, and several other advanced features are temporarily unavailable. However, symptoms can range from mild to life-threatening. Management of life-threatening airway obstruction caused by benign thyroid disease. Four patients required median sternotomy for large retrosternal extension of the goitre. Sorensen JR, Lauridsen JF, Døssing H, Nguyen N, Hegedüs L, Bonnema SJ, Godballe C. Eur Thyroid J. a number of short-term side effects that people may experience after thyroid surgery. Search for other works by this author on: Review of adult tracheomalacia and its relationship with chronic obstructive pulmonary disease, Evidence-based surgical management of substernal goiter, High incidence of tracheomalacia in longstanding goiters: experience from an endemic goiter region, Respiratory complications after thyroidectomy and the need for tracheostomy in patients with large goitre, Predictors of airway complications after thyroidectomy for substernal goiter, Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery, If nothing goes wrong, is everything all right? Until the risk of PTTM can be elucidated definitively, we would advocate performing such procedures in centres with the requisite multispeciality expertise. The probability of PTTM occurring in none of our population of 62 (i.e. In previous studies, the incidence rate was very different. 2007 Apr;31(4):832-7. doi: 10.1007/s00268-006-0565-8. Noninvasive positive pressure ventilation in the management of post-thyroidectomy tracheomalacia. While goitres are common, those causing significant anatomical distortion—particularly tracheal compression—are not. For risk management, however, we would still advocate that such patients be managed in units with multispeciality support. † There were no cases of tracheomalacia. Asleep fibreoptic intubation was performed in one patient with a trachea of 7 mm because it was the preference of the anaesthetist involved. These changes are due to damage to the laryngeal nerves that supply your voice box (larynx) during surgery. Mean length of stay was 2.4 days in those with tracheas <5 mm and 2.0 days in those >5 mm. Tracheomalacia after thyroid surgery is rare in contemporary UK practice. This is important because after thyroidectomy, there is no support to trachea and so it may collapse, causing respiratory embarrassment. Tracheomalacia is a rare condition that happens when the cartilage of the windpipe, or trachea, is soft, weak and floppy. While anatomical factors such as distortion and compression may theoretically modulate the risk of PTTM, there may be additional as yet unidentified variables. Major postoperative complications include wound infection, bleeding, airway obstruction (compressing hematoma, tracheomalacia), hypocalcemia, thyroid storm (uncommon, usually associated with Grave’s disease) and recurrent laryngeal nerve injury. Our current study has a number of limitations. Epub 2017 Sep 12. Google Scholar Findlay JM, Sadler GP, Bridge H (2011) Post-thyroidectomy tracheomalacia: minimal risk despite significant tracheal compression. Balasubramanian S, Kannan R, Balakrishnan K (2008) Post operative tracheomalacia after surgery on the thyroid gland and aerodigestive tract. All cases with preoperative computed tomography (CT) were identified. Results of surgical treatment in multinodular goiter with an intrathoracic component. 2011 Oct;25(5):745-8. doi: 10.1007/s00540-011-1181-9. Chest Surg Clin N Am. Tracheomalacia. Due to the weakened tracheal ring, the patency of the trachea is mainly maintain by thyroid. Tracheomalacia after reoperation for an adenomatous goiter located in a unique position. Tracheomalacia is a serious complication that may occur in patients after retrosternal goitre (RSG) surgery. Patient characteristics, radiological, operative, anaesthetic, and pathology data were then obtained from the patients’ medical notes and hospital computerized records. FOIA Tracheopexy. RSG is clinically and/or radiologically defined as an extension of the thyroid below the sternal notch when the patient is in the supine position (5). Our finding of zero incidence of PTTM despite significant tracheal compression adds weight to a growing consensus that PTTM remains almost mythical within modern thyroid surgery in the Western world. World J Surg. Most of the information and experience of PTTM derives predominantly from outside the Western World, often in areas of endemic and longstanding goitre.3 Risk factors considered to be associated with PTTM are the duration of goitre and retrosternal extension of goitres.3–6 Although tracheal compression is likely to be a causative variable in the development of PTTM,2 this is not completely established.3 Few studies have specifically assessed the risk of tracheomalacia in contemporary series. 1029, Volume 58, Issue 11, DOI: 10.1007/s12630-011-9570-y Symptomatic tracheal compression from thyroid enlargement is relatively rare in the developed world. The patient with the most dramatic airway impairment from the most extensive tracheomalacia experienced very satisfactory airway security. In the twelfth and thirteenth centuries, the school of Salerno in Italy was the cradle of It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Even in endemic areas, compression sufficient to result in post-thyroidectomy tracheomalacia is rare, 1 , 2 while its very existence in the developed world is questioned. Similar to an aortopexy, this procedure opens up and supports the airway by suspending the front of the tracheal wall from the back of the sternum. In a 2004 review of 1969 patients from 12 studies, Bennett and colleagues15 found 19 (0.9%) required tracheostomy with 6 (0.3%) suffering tracheomalacia. Since they were never endemic around the Mediterranean, there was no mention of goitre in Egyptian or Greek writings. Unable to load your collection due to an error, Unable to load your delegates due to an error. Tracheal compression was reported in 62 patients (19%) with minimum tracheal diameter ranging from 2 to 15 mm (mean 7.6 mm) due to multinodular goitre (n=50), malignancy (n=10), or thyroiditis (n=2). Tracheomalacia is exaggeration of the physiologic expiratory reduction in the antero-posterior diameter of the trachea causing tracheal obstruction, which results in respiratory embarrassment. Of the 62 patients with trachea <15 mm, 23 underwent thyroid lobectomy and 39 underwent total thyroidectomy. J Anesth. Although a reduction in the tracheal cartilage:soft tissue ratio from 4.5 to 2:1 has been demonstrated,1 and additional aetiological factors suggested such as loss of longitudinal elastic fibres in the pars membranacea and cartilage fragmentation, many of the pathological components remain obscure.19,20 Consequently, while tracheal compression has been labelled as a likely culprit, PTTM may indeed occur in its absence, and it may be that other factors are more important. 2008;38(6):487-94. doi: 10.1007/s00595-006-3673-z. These factors cause tracheal collapse, especially during times of increased … Significant tracheomalacia can result in tracheal collapse and respiratory obstruction after extubation after thyroidectomy. 2003 May;13(2):349-57, viii. Tracheostomy is a safe procedure and gives a good alternative to delayed endotracheal extubation in post-thyroidectomy patients expected to have respiratory failure in places where post-operative anaesthetic care is lacking. A retrospective review was conducted of thyroidectomies performed in a UK tertiary referral centre over a 30 month period. There are a number of complications after thyroid surgery such as compressing hematoma, tracheomalacia, wound infection, damage to the recurrent laryngeal nerve or superior laryngeal nerve, hypothyroidism, hypocalcemia, scar formation, and thyroid storm, but discharging skin sinus of the neck is a rare complication. The incidence of tracheomalacia was 0 (95% confidence interval 0.0–4.8%). Long-standing tracheal compression by a large goiter can, however, lead to tracheal ring softening or destruction, with a reduction of the tracheal cross-sectional area to 50% and consequent tracheal collapse after thyroidectomy, requiring tracheostomy. Tracheomalacia is a feared complication of goitre surgery, but considered rare Two patients with lethal postthyroidectomy tracheomalacia led me to anticipate this complication in certain identifiable high-risk patients in my own practice, and the cases of five patients are described for whom several techniques of tracheal support were attempted. Second scenario: trachea injury identified after the surgery The second setting, which includes delayed tracheal rupture after a thyroid surgical procedure, seems to be less rare, but it too has only been described in case reports [ 2, 4, 5, 6, 8, 9, 10, 11, 12, 13, 14, 15, 16 ]. Aetiology of the goitre in these patients was multinodular goitre (n=50), malignancy (n=10), and thyroiditis (n=2). Mean length of stay (LOS) was 2.4 days in those with tracheas <5 mm and 2.0 days in those >5 mm. RÃos A, RodrÃguez JM, Galindo PJ, Torres J, Canteras M, Balsalobre MD, Parrilla P. Surg Today. The incidence of this complication after thyroid surgery is estimated to be between 7% and 34% (depending on which study you look at (10)). Attempts to establish the true risk of PTTM have been fraught with such heterogeneity, and compounded by a lack of universal definitions and diagnostic criteria. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. During thyroid surgery two possible sites of tracheal injury exist: at the isthmus, when the thyroid is separated from the trachea, and at the area where the recurrent laryngeal nerve enters the thyroid cartilage during lateral and posterior dissection . A number of studies have assessed the risk of tracheomalacia as part of post-thyroidectomy respiratory complications. The natural history of … Also in 2004, Erbil and colleagues18 reviewed 170 cases with retrosternal goitre; of these, 50 were noted to have either tracheal deviation, compression, or both (although not quantified further), but none developed PTTM.
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