Delayed Multifocal Tracheal Injury Following Thyroidectomy: A Case Report and Review of the Literature

Shew, Matthew; Boyd, Christopher; Kraft, Shannon

doi:10.7759/cureus.8164

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…1 Delayed reports of tracheal injury are rare, and for benign pathology have been reported to occur between 3 and 40 days postoperatively. 4 There are several hypotheses for why this particular patient experienced delayed tracheal necrosis and perforation, including devitalization from thermal injury during surgery and poor wound healing in the setting of chronic corticosteroids. 2 Postoperative seroma development can lead to a devascularization injury by disrupting the tracheal vasculature, despite prompt decompression with needle aspiration.…”

Section: Discussionmentioning

confidence: 97%

“…Tracheal injury following thyroidectomy is an uncommon complication with reported incidence of 0.06%, and necessitates prompt attention due to the risk of airway compromise 1 . Delayed reports of tracheal injury are rare, and for benign pathology have been reported to occur between 3 and 40 days postoperatively 4 . There are several hypotheses for why this particular patient experienced delayed tracheal necrosis and perforation, including devitalization from thermal injury during surgery and poor wound healing in the setting of chronic corticosteroids 2 .…”

Section: Discussionmentioning

confidence: 99%

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Delayed Tracheal Perforation Following Total Thyroidectomy

2021

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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, 132:17–19, 2022

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Delayed Tracheal Perforation Following Total Thyroidectomy

2021

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“…Thyroidectomies are very commonly performed globally with relatively low surgical risks, performed for malignant and non-malignant indications [4] . There is a reported 0% mortality rate and a less than 3% complication rate.…”

Section: Discussionmentioning

confidence: 99%

“…23% underwent transposition of a myovascular flap to cover the tracheal defect without primary suture closure. One case underwent partial sternotomy due to the extent of the tracheal injury and due to evolution of the tracheal injury further underwent a tracheostomy through the defect [4] .…”

Section: Discussionmentioning

confidence: 99%

“…Bronchoscopy – 1 mm mucosal irregularity along right lateral tracheal wall inferior to cricoid + scant overlying granulation tissue. 2020 [4] USA 24M Total thyroidectomy with bilateral neck dissections Metastatic papillary thyroid cancer - Left recurrent laryngeal nerve sacrificed due to tumour involvement. Re -intubated due to stridor and respiratory distress on table.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and surgical repair of delayed tracheal perforation post thyroidectomy in context of previous cranio-spinal radiotherapy – A case report

Seenarain

Trivedi

Flukes

et al. 2022

International Journal of Surgery Case Reports

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Introduction and importance This is the first case of delayed tracheal perforation post total thyroidectomy in the context of previous radiotherapy to the neck. Such a presentation can be easily misdiagnosed and managed as a seroma at significant risk to the patient, as the latter had no precipitating factors and cardiorespiratory compromise. There are nineteen previously described cases of delayed tracheal injury post thyroidectomy of variable severity and variable intervention. Case presentation A 51-year-old man presented with non-tender anterior neck surgical emphysema initially diagnosed on bedside ultrasound and plain X-ray, 22 days following total thyroidectomy and central neck dissection. His background was significant for childhood acute lymphoblastic leukaemia requiring chemotherapy and cranio-spinal radiotherapy. He underwent total thyroidectomy, for multiple bilateral thyroid nodules found on cranio-spinal MRI surveillance concerning for follicular neoplasm. There were significant amount of adhesions tethering the thyroid secondary to prior radiotherapy but no tracheal injury intra-operatively. Clinical discussion At presentation, no source of air leak was identified on Computer Tomography. He failed conservative management. During surgical exploration, a 2 mm tracheal perforation at the right cricothyroid joint was closed with the right sternothyroid muscle due to the proximity of the perforation with the recurrent right laryngeal nerve. Tisseel was applied over the repair. He recovered without further complications. Conclusion Sudden onset neck swelling post thyroidectomy in the context of significant scaring from radiotherapy, should raise the suspicion of surgical emphysema in the neck patients and confirmed with plain x-ray. Such patients should have multidisciplinary tertiary care.

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